BACKGROUND: The rates of recanalization and reinterventions after endovascular treatment (EVT) of intracranial aneurysms are unknown. Various risk factors have been suggested including the configuration of the aneurysm and the endovascular technique. Recently, an increasing number of patients have received antiplatelet (AP) drugs periprocedurally, possibly inhibiting early thrombus formation. OBJECTIVE: To assess the impact of AP drugs on the rate of recurrence and reintervention. METHODS: Patients treated at our center were entered into a prospectively conducted database. Those with at least one follow-up angiogram 6 months after EVT were selected for the study. The role of AP medication was assessed by statistical analysis. RESULTS: 292 patients with 314 aneurysms (206 ruptured) were included. The median follow-up time was 18 months. 129 (41%) were treated with APs (70 with acetylsalicylic acid (ASA), 10 with clopidogrel and 48 with both). 107 angiographic aneurysm recurrences were noted and 61 aneurysms were retreated at least once. In a multivariate model only aneurysm size, initially incomplete occlusion and the length of follow-up were significant predictors (p<0.05). No correlation was found between AP administration and recurrences or reinterventions. Interestingly, patients receiving ASA alone were retreated less often (OR 0.187, 95% CI 0.061 to 0.572, p=0.003). CONCLUSION: AP administration is not associated with an increased rate of aneurysm recurrence or reintervention; ASA even seemed to have some beneficial effect. However, confounding factors may include the lack of standardized indications for AP and the small number of patients in the series. A prospectively conducted study is warranted to further clarify the role of AP medication after EVT.
BACKGROUND: The rates of recanalization and reinterventions after endovascular treatment (EVT) of intracranial aneurysms are unknown. Various risk factors have been suggested including the configuration of the aneurysm and the endovascular technique. Recently, an increasing number of patients have received antiplatelet (AP) drugs periprocedurally, possibly inhibiting early thrombus formation. OBJECTIVE: To assess the impact of AP drugs on the rate of recurrence and reintervention. METHODS:Patients treated at our center were entered into a prospectively conducted database. Those with at least one follow-up angiogram 6 months after EVT were selected for the study. The role of AP medication was assessed by statistical analysis. RESULTS: 292 patients with 314 aneurysms (206 ruptured) were included. The median follow-up time was 18 months. 129 (41%) were treated with APs (70 with acetylsalicylic acid (ASA), 10 with clopidogrel and 48 with both). 107 angiographic aneurysm recurrences were noted and 61 aneurysms were retreated at least once. In a multivariate model only aneurysm size, initially incomplete occlusion and the length of follow-up were significant predictors (p<0.05). No correlation was found between AP administration and recurrences or reinterventions. Interestingly, patients receiving ASA alone were retreated less often (OR 0.187, 95% CI 0.061 to 0.572, p=0.003). CONCLUSION: AP administration is not associated with an increased rate of aneurysm recurrence or reintervention; ASA even seemed to have some beneficial effect. However, confounding factors may include the lack of standardized indications for AP and the small number of patients in the series. A prospectively conducted study is warranted to further clarify the role of AP medication after EVT.
Authors: Justin E Vranic; Pablo Harker; Christopher J Stapleton; Robert W Regenhardt; Adam A Dmytriw; Naif M Alotaibi; Rajiv Gupta; Thabele M Leslie-Mazwi; Matthew J Koch; Scott B Raymond; Justin R Mascitelli; T Tyler Patterson; Joshua Seinfeld; Andrew White; David Case; Christopher Roark; Chirag D Gandhi; Fawaz Al-Mufti; Jared Cooper; Aman B Patel Journal: Neuroradiol J Date: 2021-11-07