Use of Preprocedural, Multiple Antiplatelet Medications for Coil Embolization of Ruptured Cerebral Aneurysm in the Acute Stage Improved Clinical Outcome and Reduced Thromboembolic Complications without Hemorrhagic Complications

Shimamura, Norihito; Naraoka, Masato; Matsuda, Noboru; Katayama, Kosuke; Kakuta, Kiyohide; Katagai, Takeshi; Fujiwara, Nozomi; Hasegawa, Seiko; Ohkuma, Hiroki

doi:10.1016/j.wneu.2019.09.149

Cited by 13 publications

(13 citation statements)

References 19 publications

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“…Of three studies addressing aneurysm location (Edwards et al, 1 Muraoka et al, 13 Shimamura et al 12; all retrospective, n=226), 66.8% (n=151) were located in the anterior circulation, without significant differences in location between the groups with and without AT (table 2; p=0.20, OR 0.67, 95% CI 0.38 to 1.19). Two studies reported CSF drainage (Edwards et al (1), Shimamura et al (12); all retrospective, n=109), which was significantly higher in the AT group (64.8%, 57/88) compared with the non- AT group (38.1%, 8/21) (p=0.046, OR 2.99, 95% CI 1.13 to 8.10).…”

Section: Resultsmentioning

confidence: 96%

“…Two studies reported CSF drainage (Edwards et al (1), Shimamura et al (12); all retrospective, n=109), which was significantly higher in the AT group (64.8%, 57/88) compared with the non- AT group (38.1%, 8/21) (p=0.046, OR 2.99, 95% CI 1.13 to 8.10). Three studies (Edwards et al, 1 Muraoka et al, 13 Shimamura et al 12; n=226) showed the number of patients treated by balloon assisted coiling, which was significantly higher in the AT group (61.4%, 78/127) compared with the non-AT group (37.4%, 37/99) (p<0.001, OR 2.64, 95% CI 1.54 to 4.53). Three studies (Ries et al, 9 Edwards et al, 1 Shimamura et al 13) demonstrated the size of the aneurysms.…”

Section: Resultsmentioning

confidence: 99%

“…After applying our inclusion and exclusion criteria, five articles were included in this study (table 1, online supplemental tables 1-3). 1 9–12…”

Section: Resultsmentioning

confidence: 99%

“…Two of the five studies were multicenter studies; one was a randomized controlled trial (RCT) and four were retrospective studies (three cohort1 9 13 and one case-control) 12. The RCT was carried out in the Netherlands.…”

Section: Resultsmentioning

confidence: 99%

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Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis

Takase

Tatezuki

Salem

et al. 2022

J NeuroIntervent Surg

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BackgroundEndovascular embolization using standalone coils is the preferred treatment option for ruptured cerebral aneurysms to avoid the use of dual antiplatelet therapy with stent coiling or endoluminal flow diversion devices. However, it has been reported that patients undergoing the standalone coiling approach are at risk for periprocedural thromboembolism. Therefore, this systematic review and meta-analysis was performed to clarify the risks and benefits of antiplatelet therapy (AT) during coiling procedures performed to treat ruptured aneurysms, including the incidence of early thromboembolic events, hemorrhagic and delayed ischemic events, as well as clinical outcomes.MethodsA comprehensive search of three databases was performed for articles from inception to June 2021. After fulfilling the inclusion criteria, five studies were included in this meta-analysis and 462 patients with aneurysmal subarachnoid hemorrhage (aSAH) were identified who underwent endovascular standalone coiling treatment. Aneurysm location, patient characteristics, and aSAH grades were comparable between the AT and non-AT groups.ResultsAT significantly decreased the incidence of thromboembolic events immediately after the coiling procedures compared with non-AT (OR 3.42; 95% CI 1.77 to 6.61, p<0.001). The incidences of hemorrhage, delayed ischemia, and clinical outcomes with or without AT were not significantly different between groups.ConclusionsAlthough this study showed no beneficial effect of AT on clinical outcomes, the results suggest that AT could be combined with standalone coiling to avoid thromboembolism during the perioperative period. A large prospective study and/or an additional meta-analysis would be required to further investigate how AT benefits standalone coil embolization in aSAH.

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Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

“…After applying our inclusion and exclusion criteria, five articles were included in this study (table 1, online supplemental tables 1-3). 1 9–12…”

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis

Takase

Tatezuki

Salem

et al. 2022

J NeuroIntervent Surg

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show abstract

“…How to reduce ischemic complications in clinical applications has always puzzled clinicians. One strategy is to use antiplatelet drugs prior to the selective aneurysm coil embolization operation, as it has been proven to reduce the risk of clinical thromboembolic events (24,25). How to reduce the occurrence of microemboli events with abnormal DWI during the aneurysm operation has also been studied by many researchers.…”

Section: Discussionmentioning

confidence: 99%

The Utility of Diffusion-Weighted MRI Lesions to Compare the Effects of Different Heparinization Schemes in Intracranial Aneurysms Treated by Endovascular Intervention

et al. 2020

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Objective: Heparinization is applied to prevent ischemic complications in the endovascular treatment of intracranial aneurysms, but there is no unified heparinization scheme. Diffusion-weighted imaging (DWI) can be used to evaluate ischemia after endovascular therapy for intracranial aneurysms. The goal of this study is to apply DWI to evaluate the effects of different heparinization schemes on intracranial aneurysms treated with endovascular therapy.Methods: We retrospectively reviewed 141 patients with 149 aneurysms treated with endovascular interventions from July 2019 to April 2020 at our center, including 96 aneurysms treated with local heparinization and 53 aneurysms treated with systemic heparinization. We collected the basic information of the patients, including age, sex, comorbidities, and aneurysm characteristics, and associated treatment data. New ischemic lesions detected by DWI were categorized belonging to four types. Multivariate logistic regression was used to compare the effects of different heparinization schemes on intracranial aneurysms treated with endovascular therapy.Results: There were no significant differences in age, sex, hypertension, diabetes, and aneurysm size or location between the two groups. The incidence and distribution types of DWI abnormalities in the local heparinization groups and systemic heparinization groups were not significantly different (P > 0.05). There was a correlation between the laser engraving stent and postoperative DWI abnormalities (P < 0.003). Multivariate logistic regression analysis showed that the laser engraving stent was significantly correlated with postoperative DWI abnormalities (odds ratio, 4.71; 95% CI: 1.51–14.58; P = 0.007).Conclusion: Compared with systemic heparinization, local heparinization does not increase the incidence of DWI abnormalities after endovascular treatment, and its application in this group of patients is safe and effective.

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Safety and efficacy of stent-assisted coil embolization with periprocedural dual antiplatelet therapy for the treatment of acutely ruptured intracranial aneurysms

Lee,

Ha,

Lim

et al. 2024

Acta Neurochir

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Use of Preprocedural, Multiple Antiplatelet Medications for Coil Embolization of Ruptured Cerebral Aneurysm in the Acute Stage Improved Clinical Outcome and Reduced Thromboembolic Complications without Hemorrhagic Complications

Cited by 13 publications

References 19 publications

Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis

Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis

The Utility of Diffusion-Weighted MRI Lesions to Compare the Effects of Different Heparinization Schemes in Intracranial Aneurysms Treated by Endovascular Intervention

Safety and efficacy of stent-assisted coil embolization with periprocedural dual antiplatelet therapy for the treatment of acutely ruptured intracranial aneurysms

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