Huang Xiaopeng, Zhang Tingbao, Feng Yu, Li Xiang, Liu Kui, Zhao Wenyuan
Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
Brain Research Center, Zhongnan Hospital of Wuhan University, Wuhan, China.
Front Neurol. 2025 May 1;16:1538753. doi: 10.3389/fneur.2025.1538753. eCollection 2025.
Perioperative cerebrovascular thromboembolic events are serious complications of stent-assisted embolization (SAE) for unruptured intracranial aneurysms (UIAs). To date, there have been no definitive clinical trial results to effectively predict and prevent the occurrence of this complication. This study aims to elucidate the correlation between platelet aggregation rate (PAR) and thromboembolic events (TEs), with the goal of predicting the occurrence of cerebrovascular TEs in these patients.
In this retrospective, single-center cohort study, we included 704 cases of unruptured intracranial aneurysms treated with stent-assisted intervention from 2016 to 2020. Cerebrovascular TEs were defined as cerebral ischemic events occurring within 7 days before or after the interventional procedure. Light Transmission Aggregometry (LTA) was used to detect PAR in patients. Clinical data, including patients' demographic information and perioperative PAR, were collected. Multivariate analysis was conducted to examine the correlation between these factors and the occurrence of TEs. Additionally, Lasso regression was employed to select clinical indicators associated with perioperative TEs. Receiver Operating Characteristic (ROC) curves were generated for prognostic indicators such as PAR, with the optimal cutoff value determined. A nomogram was then simulated, and predictive accuracy of the model was evaluated using Decision Curve Analysis (DCA).
A total of 562 patients were included in the final analysis. Significant differences were observed in the incidence of thrombosis between the control group and the experimental group (9.38% vs. 4.96%). The ROC curve of platelet aggregation index, highly correlated with prognosis and derived from Lasso regression, identified the optimal cutoff value for the maximum preoperative PAR as 19.81. A nomogram was constructed based on selected clinical baseline data, and its calibration was assessed using data from the prediction group. The net benefit of the experimental group model's DCA curve was significantly improved.
For patients undergoing SAE for UIAs, utilizing PAR and other indicators as reference standards for treatment results in better prognosis compared to empirical treatment based on guidelines. Guiding antiplatelet therapy using PAR and other indicators is both meaningful and beneficial to clinical practice.
围手术期脑血管血栓栓塞事件是未破裂颅内动脉瘤（UIA）支架辅助栓塞（SAE）的严重并发症。迄今为止，尚无明确的临床试验结果能有效预测和预防该并发症的发生。本研究旨在阐明血小板聚集率（PAR）与血栓栓塞事件（TE）之间的相关性，以预测这些患者脑血管TE的发生。
在这项回顾性单中心队列研究中，我们纳入了2016年至2020年接受支架辅助干预治疗的704例未破裂颅内动脉瘤病例。脑血管TE定义为介入手术前或后7天内发生的脑缺血事件。采用光透射聚集法（LTA）检测患者的PAR。收集临床资料，包括患者的人口统计学信息和围手术期PAR。进行多因素分析以检验这些因素与TE发生之间的相关性。此外，采用套索回归选择与围手术期TE相关的临床指标。为PAR等预后指标生成受试者操作特征（ROC）曲线，并确定最佳截断值。然后模拟列线图，并使用决策曲线分析（DCA）评估模型的预测准确性。
最终分析共纳入562例患者。对照组和试验组血栓形成发生率存在显著差异（9.38%对4.96%）。通过套索回归得出的与预后高度相关的血小板聚集指数的ROC曲线确定术前最大PAR的最佳截断值为19.81。基于选定的临床基线数据构建列线图，并使用预测组的数据评估其校准情况。试验组模型的DCA曲线净效益显著提高。
对于接受SAE治疗UIA的患者，与基于指南的经验性治疗相比，利用PAR和其他指标作为治疗结果的参考标准可获得更好的预后。使用PAR和其他指标指导抗血小板治疗对临床实践既有意义又有益。
