RT Journal Article
SR Electronic
T1 Impact of duration of dual anti-platelet therapy on risk of complications after stent-assisted coiling of unruptured aneurysms
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP jnis-2024-021977
DO 10.1136/jnis-2024-021977
A1 Ringer, Andrew J
A1 Hanel, Ricardo A
A1 Baig, Ammad A
A1 Siddiqui, Adnan H
A1 Lopes, Demetrius Klee
A1 Barros, Guilherme
A1 Bass, David I
A1 Levitt, Michael R
A1 Young, Christopher C
A1 Naylor, Ryan M
A1 Lanzino, Giuseppe
A1 Crowley, R Webster
A1 Serrone, Joseph C
A1 Kan, Peter T
A1 Binning, Mandy J
A1 Veznedaroglu, Erol
A1 Boulos, Alan
A1 Tawk, Rabih
A1 
YR 2024
UL http://jnis.bmj.com/content/early/2025/01/26/jnis-2024-021977.abstract
AB Background The optimal duration for dual antiplatelet therapy (DAPT) after stent-assisted coiling (SAC) of intracranial aneurysms is unclear. Longer-term therapy may reduce thrombotic complications but increase the risk of bleeding complications.Methods A retrospective review of prospectively maintained data at 12 institutions was conducted on patients with unruptured intracranial aneurysms who underwent SAC between January 1, 2016 and December 31, 2020, and were followed ≥6 months postprocedure. The type and duration of DAPT, stent(s) used, outcome, length of follow-up, complication rates, and incidence of significant in-stent stenosis (ISS) were collected.Results Of 556 patients reviewed, 450 met all inclusion criteria. Nine patients treated with DAPT <29 days after SAC and 11 treated for 43–89 days were excluded from the final analysis as none completed their prescribed duration of treatment. Eighty patients received short-term DAPT. There were no significant differences in the rate of thrombotic complications during predefined periods of risk in the short, medium, or long-term treatment groups (1/80, 1.3%; 2/188, 1.1%; and 0/162, 0%, respectively). Similarly, no differences were found in the rate of hemorrhagic complications during period of risk in any group (0/80, 0%; 3/188, 1.6%; and 1/162, 0.6%, respectively). Longer duration DAPT did not reduce ISS risk in any group.Conclusions Continuing DAPT >42 days after SAC did not reduce the risk of thrombotic complications or in-stent stenosis, although the risk of additional hemorrhagic complications remained low. It may be reasonable to discontinue DAPT after 42 days following non-flow diverting SAC of unruptured intracranial aneurysms.Data are available upon reasonable request. Email corresponding author for data request.