Incidence of cerebral ischemic events after discontinuation of clopidogrel in patients with intracranial aneurysms treated with stent-assisted techniques

Rossen, James D.; Chalouhi, Nohra; Wassef, Shafik N.; Thomas, Jacob P.; Abel, Taylor J.; Jabbour, Pascal; Kung, David; Hasan, David

doi:10.3171/2012.8.jns12185

Cited by 61 publications

(37 citation statements)

References 13 publications

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“…With the use of a stent, very wide-necked aneurysms and even fusiform aneurysms can now be treated. However, intensive and prolonged use of antiplatelet medication is required [24], which limits the use of stents for ruptured aneurysms and for patients who cannot tolerate long-term antiplatelet medication, such as patients with cancer who may need major surgery and young women who want to become pregnant in the future. Therefore, coil embolization without stenting is still the first choice for endosaccular embolization and it is important to be able to predict if an aneurysm is likely to be successfully embolized with coils alone, with or without using the balloon remodeling technique, or whether stenting is inevitable.…”

Section: Discussionmentioning

confidence: 99%

Effects of anatomic characteristics of aneurysms on packing density in endovascular coil embolization: analysis of a single center’s experience

et al. 2015

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When embolizing cerebral aneurysms, dense coil packing may prevent recanalization but this may be influenced by the aneurysm morphology. We have analyzed retrospectively the relationship between anatomic features and the volumetric coil packing density. We analyzed 452 aneurysms in 434 patients treated by coil embolization without stenting, expressing packing density as volume embolization ratio (VER, volume of inserted coils/aneurysm volume). Six morphological variables (neck width, height, maximum diameter, dome to neck ratio (DNR), and aspect ratio), aneurysm location, and whether the aneurysm was ruptured or unruptured were analyzed with respect to dense (VER ≥20%) or loose (VER <20%) packing densities, using logistic regression analysis and ROC analysis. Among 452 aneurysms, VERs >20% were achieved for 272 aneurysms, with a mean VER of 24.7%. The mean VER of the remaining 180 aneurysms was 15.6%. In univariate analyses, the predictors for dense packing were having an anterior circulation, DNR, aspect ratio, and neck width. In multivariate analysis, the independent predictors were smaller neck width (odds ratio (OR) 0.8735; 95% confidence interval (CI) 0.7635-0.9993) and larger aspect ratio (OR 1.6679; 95% CI 1.0460-2.6594). ROC analysis showed optimal cutoff values for an aspect ratio of 1.35 (sensitivity 69.5%, specificity 51.7%) and a neck width of 3.13 mm (sensitivity 51.1%, specificity 27.8%). Although dense coil packing is still difficult to achieve in wide-necked aneurysms without the use of stents, packing with VER >20% is expected to be achieved when the height is 1.35 times larger than the neck width.

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Section: Discussionmentioning

confidence: 99%

Effects of anatomic characteristics of aneurysms on packing density in endovascular coil embolization: analysis of a single center’s experience

et al. 2015

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“…Hwang et al reported rates of delayed ischemic events of 3.5% within 2 months following the switch from DAPT to SAPT [5]. Giant aneurysms, fusiform AN, incomplete occlusions, Y-stents, waffle-cone stents, stent malpositioning, Enterprise stent, and coil loop prolapse are all reported to increase the risk of delayed ischemic events after SAC [5,7,8,10,12]. Delayed in-stent restenosis is also reported to be a late complication in 2.6-14% of cases [3,7,9].…”

Section: Apt and Delayed Ischemic Event After Sacmentioning

confidence: 99%

“…After SAC, DAPT with aspirin and clopidogrel was continued for 6 weeks to 9 months, and delayed ischemic strokes occurred in 0.6-16% [3][4][5][6][7][8][9][10][11][12][13][14]. Moreover, ischemic events were more likely to occur after the transition from DAPT to SAPT [5,9,10,13,14].…”

Section: Apt and Delayed Ischemic Event After Sacmentioning

confidence: 99%

The Indication for Long-Term Oral Antiplatelet Therapy After Endovascular Embolization of Unruptured Intracranial Aneurysms

et al. 2016

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“…In a similar context, Lee et al 6) reported that delayed infarction occurred in 11 of 261 (4.2%). Further, Rossen et al 12) reported that discontinuation of clopidogrel therapy was associated with a 5% risk of ischemic events in patients who have undergone treatment with stent techniques. These reports suggest that some patients who have undergone ES-assisted procedures require lifelong dual AT therapy.…”

Section: Discussionmentioning

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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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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Incidence of cerebral ischemic events after discontinuation of clopidogrel in patients with intracranial aneurysms treated with stent-assisted techniques

Cited by 61 publications

References 13 publications

Effects of anatomic characteristics of aneurysms on packing density in endovascular coil embolization: analysis of a single center’s experience

Effects of anatomic characteristics of aneurysms on packing density in endovascular coil embolization: analysis of a single center’s experience

The Indication for Long-Term Oral Antiplatelet Therapy After Endovascular Embolization of Unruptured Intracranial Aneurysms

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

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