PMID- 37119114
OWN - NLM
STAT- MEDLINE
DCOM- 20231108
LR  - 20231108
IS  - 1933-0693 (Electronic)
IS  - 0022-3085 (Linking)
VI  - 139
IP  - 5
DP  - 2023 Nov 1
TI  - Safety of discontinuing antiplatelet therapy 12-24 months after stent-assisted 
      coil embolization: a multicenter retrospective study.
PG  - 1311-1316
LID - 10.3171/2023.3.JNS222177 [doi]
AB  - OBJECTIVE: Antiplatelet medication is required after stent-assisted coil 
      embolization (SACE) to avoid thromboembolic complications. Currently, there is no 
      consensus on how long the antiplatelet agent should be maintained. The authors 
      investigated clinical outcomes in patients who discontinued their antiplatelet 
      agent 12-24 months after SACE. METHODS: Data were retrieved from a prospective 
      database for 373 consecutive patients with SACE at 6 institutions who 
      discontinued antiplatelet therapy 12-24 months after SACE. Thromboembolic 
      complications associated with discontinuation were defined as neurological or 
      radiographic ischemia that occurred within 6 months after discontinuation of the 
      antiplatelet agent; the lesion had to be correlated with the territory of the 
      stented artery. RESULTS: The mean time until discontinuation of the antiplatelet 
      medication was 15.8 +/- 4.7 months after SACE (12-18 months, n = 271; 19-24 months, 
      n = 102). The most common location of treated aneurysms was the internal carotid 
      artery (n = 223, 59.8%). A laser-cut open-cell stent was most commonly applied (n 
      = 236/388, 60.8%), followed by laser-cut closed-cell stents (n = 119, 30.7%) and 
      braided closed-cell (n = 33, 8.5%); double stenting was applied in 15 aneurysms. 
      There were no patients who experienced cerebral ischemia related to 
      discontinuation of antiplatelet medications, except for 1 patient at high risk of 
      ischemia (0.27%, 95% CI 0.01%-1.48%). CONCLUSIONS: These results suggest that it 
      may be safe to discontinue antiplatelet medication after SACE in patients at low 
      risk for ischemia, and that it appears safe to discontinue the agent at 
      approximately 15 months after the procedure. Large cohort-based prospective 
      studies or randomized clinical trials are warranted to confirm these results.
FAU - Kim, Chang Hyeun
AU  - Kim CH
AD  - 1Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan 
      National University School of Medicine, Yangsan.
FAU - Hong, Noah
AU  - Hong N
AD  - 2Department of Neurosurgery, Seoul Metropolitan Government-Seoul National 
      University Boramae Medical Center, Seoul National University College of Medicine, 
      Seoul.
FAU - Rhim, Jong-Kook
AU  - Rhim JK
AD  - 3Department of Neurosurgery, Jeju National University Hospital, Jeju National 
      University College of Medicine, Seoul.
FAU - Mun, Jong Hyeon
AU  - Mun JH
AD  - 4Department of Neurosurgery, Kwangju Christian Hospital, Gwangju.
FAU - Lim, Jeongwook
AU  - Lim J
AD  - 5Department of Neurosurgery, Chungnam National University Sejong Hospital, 
      Chungnam National University School of Medicine, Daejeon.
FAU - Choi, Hyun Ho
AU  - Choi HH
AD  - 6Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University 
      College of Medicine, Seoul; and.
FAU - Kim, Young Ha
AU  - Kim YH
AD  - 1Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan 
      National University School of Medicine, Yangsan.
FAU - Lee, Sang Weon
AU  - Lee SW
AD  - 1Department of Neurosurgery, Pusan National University Yangsan Hospital, Pusan 
      National University School of Medicine, Yangsan.
FAU - Cho, Young Dae
AU  - Cho YD
AD  - 7Department of Radiology, Seoul National University Hospital, Seoul National 
      University College of Medicine, Seoul, Korea.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20230428
PL  - United States
TA  - J Neurosurg
JT  - Journal of neurosurgery
JID - 0253357
RN  - 0 (Platelet Aggregation Inhibitors)
SB  - IM
MH  - Humans
MH  - *Embolization, Therapeutic/adverse effects/methods
MH  - Ischemia/drug therapy/etiology
MH  - *Platelet Aggregation Inhibitors/therapeutic use
MH  - Retrospective Studies
MH  - Stents/adverse effects
MH  - Thromboembolism/etiology/prevention & control
MH  - Treatment Outcome
OTO - NOTNLM
OT  - aneurysm
OT  - antiplatelet
OT  - coil
OT  - embolization
OT  - stent
OT  - vascular disorders
EDAT- 2023/04/29 19:43
MHDA- 2023/11/03 06:44
CRDT- 2023/04/29 07:23
PHST- 2022/09/19 00:00 [received]
PHST- 2023/03/21 00:00 [accepted]
PHST- 2023/11/03 06:44 [medline]
PHST- 2023/04/29 19:43 [pubmed]
PHST- 2023/04/29 07:23 [entrez]
AID - 10.3171/2023.3.JNS222177 [doi]
PST - epublish
SO  - J Neurosurg. 2023 Apr 28;139(5):1311-1316. doi: 10.3171/2023.3.JNS222177. Print 
      2023 Nov 1.