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692 Impact of Dual Antiplatelet Therapy After Stent-assisted Coiling of Unruptured Aneurysms on Risk of Complications
Abstract   Peer reviewed

692 Impact of Dual Antiplatelet Therapy After Stent-assisted Coiling of Unruptured Aneurysms on Risk of Complications

Andrew J. Ringer, Ricardo Hanel, Ammad Baig, Adnan Hussain Siddiqui, Demetrius K. Lopes, Michael Robert Levitt, Ryan M. Naylor, Giuseppe Lanzino, R. Webster Crowley, Joseph Serrone, …
Neurosurgery, v 70(Supplement_1), pp 158-159
Apr 2024
DOI: https://doi.org/10.1227/neu.0000000000002809_692
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https://doi.org/10.1227/neu.0000000000002809_692View
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Abstract

INTRODUCTION: Despite some consensus on the need for perioperative dual antiplatelet therapy (DAPT) after stent-assisted coiling (SAC), the ideal duration of therapy is not clear. METHODS: Ten institutions retrospectively reviewed data from databases prospectively maintained as part of a collaborative research group. Patients with unruptured intracranial aneurysms treated with DAPT following SAC (excluding flow diverters) between January 1, 2016 and December 31, 2020 with at least 6 months follow-up. Records were reviewed for type and duration of DAPT before and after SAC, type of stent, outcome (mRS), follow-up duration, peri-procedural and delayed complications, and rate of significant in-stent stenosis. Complications were considered “during period of risk” if they occurred during DAPT when short term had completed (hemorrhagic) or after completing DAPT when long term continued (thrombotic). RESULTS: 556 patients were reviewed. 450 met all inclusion criteria. Nine patients treated for fewer than 29 days after SAC and 10 treated 43-89 days were excluded from analysis. 80 were treated with short-term DAPT (30-42 days), 188 with medium term (90-179 days), and 163 with long term (180+ days). There were no significant differences in the rate of thrombotic complications during the period of risk in short (1/80; 1.25%), medium (2/188; 1.1%) or long (0/163; 0%) term groups, but rates of hemorrhagic complications were lower in the short-term group (0/80; 0%) versus medium (3/188; 1.6%) or long (1/163; 0.6%). Longer duration DAPT did not reduce the risk of in-stent stenosis (0%; 2.5%; 3.2%). CONCLUSIONS: Continuing DAPT beyond 42 days after SAC did not reduce the risk of thrombotic complications or in-stent stenosis and may increase the risk of hemorrhagic complications. It may be reasonable to discontinue DAPT after 42 days following SAC.

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