Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Korea (the Republic of).
Department of Neurology, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin-si, Gyeonggi-do, Korea (the Republic of)
Stroke Vasc Neurol. 2024 Nov 5;9(5):560-567. doi: 10.1136/svn-2023-002882.
Stent-assisted coil embolisation (SACE) for the treatment of unruptured cerebral aneurysms has been increasingly used. Long-term advantages of antiplatelet therapy (APT) post-SACE treatment are still not well understood. We investigated the long-term effects of APT on clinical prognosis after SACE.
We conducted a retrospective study using nationwide health insurance claims data from South Korea, including patients with cerebral aneurysm treated with SACE from January 2009 to December 2020. The study outcomes consisted of the occurrence of cerebral infarction and major haemorrhage. To evaluate the impact of APT, we employed a multivariable time-dependent Cox proportional hazards regression model for each of the three distinct periods: 1-12 months, 12-24 months and >24 months after SACE.
This study included 17 692 unruptured cerebral aneurysm patients treated with SACE. During the mean follow-up of 4.2 years, there were 379 (2.1%) patients with cerebral infarction and 190 (1.1%) patients with major haemorrhage. The percentage of patients receiving APT was 79.5% at 1 year, which gradually decreased to 58.3% at 2 years after SACE. APT was beneficial in preventing cerebral infarction within 12 months after SACE (adjusted HR (aHR) 0.56; 95% CI, 0.35 to 0.89; p=0.014). After 12 months, this association was not evident. APT increased the risk of haemorrhage after 24 months (aHR 1.76; 95% CI 1.11 to 2.87; p=0.016).
Our findings suggest that in patients with unruptured cerebral aneurysm treated with SACE, the reasonable duration of APT for preventing cerebral infarction might be 1 year after SACE.
支架辅助弹簧圈栓塞术（SACE）治疗未破裂脑动脉瘤的应用日益广泛。然而，SACE 治疗后抗血小板治疗（APT）的长期优势仍未得到充分理解。本研究旨在探讨 APT 对 SACE 后临床预后的长期影响。
本研究采用回顾性队列研究，利用韩国全国健康保险索赔数据，纳入 2009 年 1 月至 2020 年 12 月期间接受 SACE 治疗的脑动脉瘤患者。研究结局包括脑梗死和大出血的发生。为评估 APT 的影响，我们采用多变量时间依赖性 Cox 比例风险回归模型，分别对 SACE 后 1-12 个月、12-24 个月和>24 个月的三个不同时期进行分析。
本研究共纳入 17692 例接受 SACE 治疗的未破裂脑动脉瘤患者。平均随访 4.2 年后，379 例（2.1%）患者发生脑梗死，190 例（1.1%）患者发生大出血。SACE 后 1 年时，接受 APT 的患者比例为 79.5%，随后逐渐降至 2 年后的 58.3%。APT 在 SACE 后 12 个月内预防脑梗死有益（校正 HR，0.56；95%CI，0.35 至 0.89；p=0.014）。12 个月后，这种关联不明显。APT 增加了 24 个月后出血的风险（校正 HR，1.76；95%CI，1.11 至 2.87；p=0.016）。
本研究结果提示，对于接受 SACE 治疗的未破裂脑动脉瘤患者，预防脑梗死的合理 APT 时间可能为 SACE 后 1 年。
