Abstract：
BACKGROUND: The optimal duration for dual antiplatelet therapy (DAPT) after stent-assisted coiling (SAC) of intracranial aneurysms is unclear. Longer-term therapy may reduce thrombotic complications but increase the risk of bleeding complications.
METHODS: A retrospective review of prospectively maintained data at 12 institutions was conducted on patients with unruptured intracranial aneurysms who underwent SAC between January 1, 2016 and December 31, 2020, and were followed ≥6 months postprocedure. The type and duration of DAPT, stent(s) used, outcome, length of follow-up, complication rates, and incidence of significant in-stent stenosis (ISS) were collected.
RESULTS: Of 556 patients reviewed, 450 met all inclusion criteria. Nine patients treated with DAPT <29 days after SAC and 11 treated for 43-89 days were excluded from the final analysis as none completed their prescribed duration of treatment. Eighty patients received short-term DAPT. There were no significant differences in the rate of thrombotic complications during predefined periods of risk in the short, medium, or long-term treatment groups (1/80, 1.3%; 2/188, 1.1%; and 0/162, 0%, respectively). Similarly, no differences were found in the rate of hemorrhagic complications during period of risk in any group (0/80, 0%; 3/188, 1.6%; and 1/162, 0.6%, respectively). Longer duration DAPT did not reduce ISS risk in any group.
CONCLUSIONS: Continuing DAPT >42 days after SAC did not reduce the risk of thrombotic complications or in-stent stenosis, although the risk of additional hemorrhagic complications remained low. It may be reasonable to discontinue DAPT after 42 days following non-flow diverting SAC of unruptured intracranial aneurysms.
METHODS: A retrospective review of prospectively maintained data at 12 institutions was conducted on patients with unruptured intracranial aneurysms who underwent SAC between January 1, 2016 and December 31, 2020, and were followed ≥6 months postprocedure. The type and duration of DAPT, stent(s) used, outcome, length of follow-up, complication rates, and incidence of significant in-stent stenosis (ISS) were collected.
RESULTS: Of 556 patients reviewed, 450 met all inclusion criteria. Nine patients treated with DAPT <29 days after SAC and 11 treated for 43-89 days were excluded from the final analysis as none completed their prescribed duration of treatment. Eighty patients received short-term DAPT. There were no significant differences in the rate of thrombotic complications during predefined periods of risk in the short, medium, or long-term treatment groups (1/80, 1.3%; 2/188, 1.1%; and 0/162, 0%, respectively). Similarly, no differences were found in the rate of hemorrhagic complications during period of risk in any group (0/80, 0%; 3/188, 1.6%; and 1/162, 0.6%, respectively). Longer duration DAPT did not reduce ISS risk in any group.
CONCLUSIONS: Continuing DAPT >42 days after SAC did not reduce the risk of thrombotic complications or in-stent stenosis, although the risk of additional hemorrhagic complications remained low. It may be reasonable to discontinue DAPT after 42 days following non-flow diverting SAC of unruptured intracranial aneurysms.
摘要：
背景：颅内动脉瘤支架辅助盘绕（SAC）后双重抗血小板治疗（DAPT）的最佳持续时间尚不清楚。长期治疗可以减少血栓并发症，但增加出血并发症的风险。
方法：对在2016年1月1日至2020年12月31日期间接受SAC且术后≥6个月随访的未破裂颅内动脉瘤患者，对12个机构的前瞻性数据进行了回顾性分析。DAPT的类型和持续时间，使用的支架，结果,随访时间，并发症发生率,收集显著支架内狭窄(ISS)的发生率。
结果：在556例患者中，450符合所有纳入标准。在SAC后用DAPT<29天治疗的9名患者和治疗43-89天的11名患者被从最终分析中排除,因为没有人完成他们规定的治疗持续时间。80例患者接受短期DAPT治疗。在短期的预定风险期间，血栓并发症的发生率没有显着差异，中等,或长期治疗组（1/80，1.3%；2/188，1.1%；0/162，0%，分别)。同样，任何组的危险期出血性并发症发生率均无差异(0/80,0%;3/188,1.6%;1/162,0.6%,分别)。持续时间较长的DAPT并没有降低任何组的ISS风险。
结论：SAC后42天继续DAPT并没有降低血栓并发症或支架内狭窄的风险，尽管其他出血性并发症的风险仍然很低。未破裂的颅内动脉瘤未分流SAC后42天后停止DAPT可能是合理的。
方法：对在2016年1月1日至2020年12月31日期间接受SAC且术后≥6个月随访的未破裂颅内动脉瘤患者，对12个机构的前瞻性数据进行了回顾性分析。DAPT的类型和持续时间，使用的支架，结果,随访时间，并发症发生率,收集显著支架内狭窄(ISS)的发生率。
结果：在556例患者中，450符合所有纳入标准。在SAC后用DAPT<29天治疗的9名患者和治疗43-89天的11名患者被从最终分析中排除,因为没有人完成他们规定的治疗持续时间。80例患者接受短期DAPT治疗。在短期的预定风险期间，血栓并发症的发生率没有显着差异，中等,或长期治疗组（1/80，1.3%；2/188，1.1%；0/162，0%，分别)。同样，任何组的危险期出血性并发症发生率均无差异(0/80,0%;3/188,1.6%;1/162,0.6%,分别)。持续时间较长的DAPT并没有降低任何组的ISS风险。
结论：SAC后42天继续DAPT并没有降低血栓并发症或支架内狭窄的风险，尽管其他出血性并发症的风险仍然很低。未破裂的颅内动脉瘤未分流SAC后42天后停止DAPT可能是合理的。
