Delayed Thrombosis or Stenosis Following Enterprise-Assisted Stent-Coiling: Is It Safe? Midterm Results of the Interstate Collaboration of Enterprise Stent Coiling

Mocco, J; Fargen, Kyle M; Albuquerque, Felipe C.; Bendok, Bernard R.; Boulos, Alan S.; Carpenter, Jeffrey; Fiorella, David; Hoh, Brian L.; Howington, Jay U.; Liebman, Kenneth; Natarajan, Sabareesh K.; Ansaar, T; Rodríguez‐Mercado, Rafael; Siddiqui, Adnan H.; Snyder, Kenneth V.; Veznedaroglu, Erol; Hopkins, L. Nelson; Levy, Elad I.

doi:10.1227/neu.0b013e318228490c

Cited by 116 publications

(91 citation statements)

References 25 publications

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“…For example, Mocco et al 5) reported that delayed thrombotic events occurred in 7 of 213 (3%) patients after ESassisted coiling in whom dual AT therapy was terminated. In a similar context, Lee et al 6) reported that delayed infarction occurred in 11 of 261 (4.2%).…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] However, some of these patients require suspension of AT if the need for surgery or biopsy arises, and some studies have reported that delayed infarction can occur after cessation or modification of AT in patients who have undergone coiling with ES. [5][6][7] Conversely, long-term AT therapy is associated with a significant risk of hemorrhagic complications. 8,9) Therefore, the aim of our study was to evaluate whether AT could be terminated without increasing the risk of ischemic events among patients who have undergone ES-assisted cerebral aneurysm coiling.…”

Section: Introductionmentioning

confidence: 99%

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Enterprise Stent-assisted Cerebral Aneurysm Coiling: Can Antiplatelet Therapy be Terminated after Neointima Formation with the Enterprise Stent?

Takayama

Taoka

Myouchin

et al. 2016

JNET

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Objective: Patients who undergo Enterprise stent (ES)-assisted cerebral aneurysm coiling require long-term antiplatelet therapy (AT). Some studies have reported that cessation or modification of AT increases the risk of cerebral infarction.The aim of this study was to evaluate whether AT can terminated without increasing the risk of ischemic events among patients who have undergone ES-assisted cerebral aneurysm coiling. Methods:This study evaluated 9 with 11 unruptured aneurysms were confirmed to have neointima formation with the ES on follow-up angiography. Dual AT was given for ≥3 months postoperatively, then one antiplatelet agent was administered until ≥6 months postoperatively before termination of all AT. Incidences of ipsilateral ischemic events and stent occlusion after AT termination were assessed prospectively.Results: During follow-up (mean, 32.8 months; range, 21.5-51.3 months) ipsilateral ischemic events and stent occlusion did not occur in any cases. Conclusion:Termination of AT ≥6 months postoperatively did not result in ischemic events among patients with neointima formation after ES-assisted cerebral aneurysm coiling.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Enterprise Stent-assisted Cerebral Aneurysm Coiling: Can Antiplatelet Therapy be Terminated after Neointima Formation with the Enterprise Stent?

Takayama

Taoka

Myouchin

et al. 2016

JNET

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“…2,6,8) Delayed in-stent occlusion was found in 1 of 110 patients who received stentassisted coil embolization for intracranial aneurysms, and manifested as neurological symptoms. 8) The occlusion occurred after the cessation of double-antiplatelet therapy. 8) Delayed in-stent stenosis occurred in 7 of 156 cases (4.5%).…”

Section: Discussionmentioning

confidence: 99%

“…8) The occlusion occurred after the cessation of double-antiplatelet therapy. 8) Delayed in-stent stenosis occurred in 7 of 156 cases (4.5%). 2) Most were asymptomatic and resolved without additional intervention.…”

Section: Discussionmentioning

confidence: 99%

“…4,7,9) Delayed in-stent occlusion has also been reported for the treatment of aneurysms. 2,6,8) Most cases of delayed in-stent occlusions were thromboembolic occlusions due to cessation of double-antiplatelet therapy or progression of in-stent stenosis. We report a case of asymptomatic delayed in-stent occlusion after stent-assisted coil embolization due to changes in the vascular geometry caused by the stent placement.…”

Section: Introductionmentioning

confidence: 99%

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Delayed In-Stent Occlusion Due to Stent-Related Changes in Vascular Geometry After Cerebral Aneurysm Treatment

Kono

Shintani

Tanaka

et al. 2013

Neurol. Med. Chir.(Tokyo)

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Stent-assisted coil embolization has been recently accepted as a treatment option for wide-neck or complex cerebral aneurysms. Delayed in-stent occlusion is described due to stent-related changes in vascular geometry. A 66-year-old man underwent stent-assisted coil embolization for an unruptured aneurysm of the vertebral artery. The treatment was successfully performed using the Enterprise stent. Follow-up angiography at 6 months showed asymptomatic in-stent occlusion. Three-dimensional analysis of the vascular geometry revealed that the left vertebral artery was straightened by 409due to the stent placement. Such straightening of the vessel presumably caused kinking and occlusion of the vessel. Stent-related changes in vascular geometry may cause kinking of a vessel and result in occlusion after the treatment of cerebral aneurysms. Pre-treatment strategy may avoid this risk.

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Standard vs Modified Antiplatelet Preparation for Preventing Thromboembolic Events in Patients With High On-Treatment Platelet Reactivity Undergoing Coil Embolization for an Unruptured Intracranial Aneurysm

et al. 2015

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IMPORTANCE Thromboembolism is the most common complication in coiling for an unruptured aneurysm and is frequent in patients with high on-treatment platelet reactivity (HTPR) who are prescribed a standard antiplatelet preparation for its prevention.OBJECTIVE To evaluate the effect of a modified antiplatelet preparation compared with a standard preparation in patients with HTPR undergoing coiling. DESIGN, SETTING, AND PARTICIPANTSA prospective randomized open-label active-control trial with blinded outcome assessment at the Seoul National University Bundang Hospital from May 27, 2013, to April 7, 2014. Patients with HTPR were randomly assigned (1 to 1) to the standard or modified preparation group. Patients without HTPR were assigned to the non-HTPR group. A total of 228 patients undergoing coiling for unruptured aneurysms were enrolled and allocated to the study, 126 in the HTPR group (63 to the standard preparation group and 63 to the modified preparation group) and 102 to the non-HTPR group. Intent-to-treat analysis was performed. INTERVENTIONSThe modified preparation (HTPR to aspirin, 300 mg of aspirin and 75 mg of clopidogrel bisulfate; and HTPR to clopidogrel, 200 mg of cilostazol added to the standard regimen) was performed before coiling in the modified preparation group. Standard preparation (100 mg of aspirin and 75 mg of clopidogrel) was maintained in the standard preparation and non-HTPR groups. MAIN OUTCOMES AND MEASURESThe primary outcome was a thromboembolic event defined as thromboembolism during coiling and a transient ischemic attack or ischemic stroke within 7 days after coiling. The principal secondary outcome was a bleeding complication according to Thrombolysis in Myocardial Infarction bleeding criteria within 30 days after coil embolization. RESULTSThe thromboembolic event rate was low in the modified preparation group (1 of 63 [1.6%]) compared with the standard preparation group (7 of 63 [11.1%]; adjusted risk difference, −11.7% [95% CI, −21.3% to −2.0%]; P = .02), which had a higher thromboembolic risk than the non-HTPR group (1 of 102 [1.0%]; adjusted risk difference, 8.6% [95% CI, 1.0% to 16.3%]; P = .03). All bleeding complications were of minimal grade according to Thrombolysis in Myocardial Infarction bleeding criteria. The bleeding rate was not different between the modified (6 of 63 [9.5%]) and standard (4 of 63 [6.3%]) preparation groups (adjusted risk difference, 5.6% [95% CI, −4.2% to 15.4%]; P = .26). CONCLUSIONS AND RELEVANCEModified antiplatelet preparation for patients with HTPR compared with standard antiplatelet preparation reduced the thromboembolic event rate in coiling for an unruptured aneurysm without increasing bleeding.TRIAL REGISTRATION Clinical Research Information Service Identifier: KCT0000804.

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Delayed Thrombosis or Stenosis Following Enterprise-Assisted Stent-Coiling: Is It Safe? Midterm Results of the Interstate Collaboration of Enterprise Stent Coiling

Abstract: Midterm occlusion rates are excellent, and stenosis and thrombosis rates are comparable to other available neurovascular stents. Interruption of antiplatelet therapy appears to be a factor in those developing delayed stenosis or thrombosis.

Cited by 116 publications

References 25 publications

Enterprise Stent-assisted Cerebral Aneurysm Coiling: Can Antiplatelet Therapy be Terminated after Neointima Formation with the Enterprise Stent?

Enterprise Stent-assisted Cerebral Aneurysm Coiling: Can Antiplatelet Therapy be Terminated after Neointima Formation with the Enterprise Stent?

Delayed In-Stent Occlusion Due to Stent-Related Changes in Vascular Geometry After Cerebral Aneurysm Treatment

Standard vs Modified Antiplatelet Preparation for Preventing Thromboembolic Events in Patients With High On-Treatment Platelet Reactivity Undergoing Coil Embolization for an Unruptured Intracranial Aneurysm

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