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Radiology. 2014 Oct;273(1):194-201. doi: 10.1148/radiol.14140070. Epub 2014 Jun 11.

Delayed ischemic stroke after stent-assisted coil placement in cerebral aneurysm: characteristics and optimal duration of preventative dual antiplatelet therapy.

Author information

1
From the Department of Neurosurgery, Seoul National University Bundang Hospital, 300 Gumi-dong, Bungdang-gu, Seongnam, Gyeonggi 463-707, Korea (G.H., N.M.P., S.J.P., E.A.J., O.K.K.); Department of Neurosurgery, New Korea Hospital, Gimpo, Korea (J.G.K., K.S.S.); Department of Neurosurgery, Pohang Stroke and Spine Hospital, Pohang, Korea (Y.J.L.); Department of Neuroscience, Section of Neurosurgery, Makati Medical Center, Makati, Philippines (J.B.V.); and Department of Neurosurgery, Airlangga University, Dr Sutomo General Hospital, Surabaya, Indonesia (N.S.S.).

Abstract

PURPOSE:

To evaluate characteristics of delayed ischemic stroke after stent-assisted coil placement in cerebral aneurysms and to determine the optimal duration of dual antiplatelet therapy for its prevention.

MATERIALS AND METHODS:

This retrospective study was approved by the institutional review board, and the requirement to obtain written informed consent was waived. Of 1579 patients with 1661 aneurysms, 395 patients (25.0%) with 403 aneurysms (24.3%) treated with stent-assisted coil placement were included and assigned to groups stratified as early (126 patients [31.9%]; 3 months of coil placement), midterm (160 patients [40.5%]; 6 months), or late (109 patients [27.6%]; ≥ 9 months), according to the time points of switching dual antiplatelet therapy to monotherapy from coil placement. Cumulative rates of delayed ischemic stroke in each group were calculated by using Kaplan-Meier estimates that were compared with log-rank tests. Risk factors of delayed ischemic stroke were identified by using Cox proportional hazard analysis.

RESULTS:

Delayed ischemic stroke occurred in 3.5% of all cases (embolism, 3.0%; thrombotic occlusion, 0.5%) within 2 months following the switch. Late switch yielded no delayed ischemic stroke, unlike early (seven of 126 patients [5.6%]; P = .013) or midterm (seven of 160 patients [4.4%]; P = .028) switch. Incomplete occlusion (hazard ratio, 6.68 [95% confidence interval: 1.490, 29.900]) was identified as a risk factor.

CONCLUSION:

Delayed ischemic stroke after stent-assisted coil placement is caused by embolism from or thrombotic occlusion of stent-containing vessels after switching from dual antiplatelet therapy to monotherapy. The stent-containing vessel with incomplete aneurysm occlusion presents as a long-term thromboembolic source. Therefore, dual antiplatelet therapy for more than 9 months and late switch to monotherapy are recommended for its prevention.

PMID:
24918960
DOI:
10.1148/radiol.14140070
[Indexed for MEDLINE]

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