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Discontinuation of antiplatelet therapy after stent-assisted coil embolisation of cerebral aneurysm: a nationwide cohort study

Authors
 Minyoul Baik  ;  Jimin Jeon  ;  Jinkwon Kim  ;  Joonsang Yoo 
Citation
 STROKE AND VASCULAR NEUROLOGY, Vol.9(5) : 560-567, 2024-11 
Journal Title
STROKE AND VASCULAR NEUROLOGY
Issue Date
2024-11
MeSH
Adult ; Aged ; Cerebral Infarction / epidemiology ; Cerebral Infarction / etiology ; Cerebral Infarction / prevention & control ; Databases, Factual ; Drug Administration Schedule ; Embolization, Therapeutic* / adverse effects ; Embolization, Therapeutic* / instrumentation ; Endovascular Procedures / adverse effects ; Endovascular Procedures / instrumentation ; Female ; Humans ; Intracranial Aneurysm* / diagnostic imaging ; Intracranial Aneurysm* / therapy ; Male ; Middle Aged ; Platelet Aggregation Inhibitors* / administration & dosage ; Platelet Aggregation Inhibitors* / adverse effects ; Platelet Aggregation Inhibitors* / therapeutic use ; Republic of Korea / epidemiology ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Stents* ; Time Factors ; Treatment Outcome ; Withholding Treatment
Keywords
Aneurysm ; Stents ; Stroke
Abstract
Introduction: 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.

Patients and methods: 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.

Results: 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).

Discussion and conclusion: 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.
Files in This Item:
T202407005.pdf Download
DOI
10.1136/svn-2023-002882
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jinkwon(김진권) ORCID logo https://orcid.org/0000-0003-0156-9736
Baik, Minyoul(백민렬)
Yoo, Joon Sang(유준상) ORCID logo https://orcid.org/0000-0003-1169-6798
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/201373
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