Fukutome Kenji, Aketa Shuta, Fukumori Junji, Fujita Taigi, Fukunaga Motoki, Shiraishi Yuki, Shimotsuma Atsuko, Murakami Yasutaka, Matsuoka Ryuta, Shiba Mikio, Tei Rinsei, Shin Yasushi, Higuchi Yoshiharu, Motoyama Yasushi
Department of Neurosurgery, Osaka Keisatsu Hospital, Osaka, Japan.
Department of Neurology, Osaka Keisatsu Hospital, Osaka, Japan.
Front Neurol. 2025 Aug 29;16:1649290. doi: 10.3389/fneur.2025.1649290. eCollection 2025.
Flow diverters (FDs) are commonly used to treat intracranial aneurysms with wide necks. Dual antiplatelet therapy (DAPT) is essential during the perioperative period to prevent thrombosis; however, it increases the risk of hemorrhagic complications, warranting early discontinuation when feasible. Neointimal formation over FD is crucial for safe DAPT discontinuation. This study aimed to directly visualize neointimal coverage 6 months after FD placement using angioscopy and evaluate the safety of DAPT termination.
Eight consecutive patients undergoing FD placement for internal carotid artery aneurysms between April 2022 and February 2024 were included in the prospective evaluation. Angioscopy was conducted at 6 months (±1 month) after FD placement to assess neointimal formation, which was graded 0-3 based on coverage (grade 0: no neointima; grade 1: slight; grade 2: translucent coverage; grade 3: full opaque coverage). Cone-beam computed tomography (CT) was concurrently performed to evaluate radiolucent gaps as indirect evidence of neointima formation. DAPT was discontinued if the neointimal coverage was graded ≥1, followed by the monitoring of ischemic events for 1 month.
The mean age of patients was 60.5 (49-81) years, and the mean aneurysm diameter was 7.7 mm (5.1-14.6 mm). Angioscopic neointimal grading was ≥1 in all cases, while cone-beam CT revealed no radiolucent gaps in one case. No procedural complications were observed. Following DAPT discontinuation, all the patients were administered single antiplatelet therapy, with no ischemic events observed within 1 month.
Angioscopy reliably confirmed neointimal coverage 6 months after FD placement, suggesting the potential for safe DAPT discontinuation. The findings underscore the superiority of angioscopy over cone-beam CT in identifying thin neointima. Further studies involving larger cohorts and applying advanced imaging technologies are required to optimize post-FD antiplatelet therapy.
血流导向装置（FDs）常用于治疗宽颈颅内动脉瘤。围手术期双重抗血小板治疗（DAPT）对于预防血栓形成至关重要；然而，这会增加出血并发症的风险，因此在可行的情况下应尽早停药。FD上的新生内膜形成对于安全停用DAPT至关重要。本研究旨在使用血管内镜直接观察FD置入6个月后的新生内膜覆盖情况，并评估停用DAPT的安全性。
前瞻性评估纳入了2022年4月至2024年2月期间连续8例因颈内动脉动脉瘤接受FD置入的患者。在FD置入后6个月（±1个月）进行血管内镜检查，以评估新生内膜形成情况，根据覆盖程度分为0 - 3级（0级：无新生内膜；1级：轻微；2级：半透明覆盖；3级：完全不透明覆盖）。同时进行锥形束计算机断层扫描（CT）以评估射线可透间隙，作为新生内膜形成的间接证据。如果新生内膜覆盖分级≥1级，则停用DAPT，随后监测1个月的缺血事件。
患者的平均年龄为60.5（49 - 81）岁，动脉瘤平均直径为7.7 mm（5.1 - 14.6 mm）。所有病例的血管内镜新生内膜分级均≥1级，而锥形束CT显示1例无射线可透间隙。未观察到手术并发症。停用DAPT后，所有患者均接受单一抗血小板治疗，1个月内未观察到缺血事件。
血管内镜可靠地证实了FD置入6个月后的新生内膜覆盖情况，表明有可能安全停用DAPT。研究结果强调了血管内镜在识别薄新生内膜方面优于锥形束CT。需要进一步开展涉及更大样本量并应用先进成像技术的研究，以优化FD术后抗血小板治疗。
