Purpose

Endovascular treatment of unruptured intracranial aneurysms with stent-assisted coiling or flow diverter stents requires a prophylactic antiplatelet premedication to avoid thrombo-embolic complications. Guidelines for optimal antiplatelet regimens are poorly defined. The aim of this study is to report our experience using a high dosage antiplatelet premedication regimen for patients with unruptured intracranial aneurysms undergoing endovascular treatment by stent-assisted coiling or flow diverter stents.

Methods

From a retrospective analysis of a prospectively maintained database, we collected clinical and angiographic data of 400 procedures in 362 patients treated by stent-assisted coiling or flow diverter stents for 419 unruptured intracranial aneurysms. Descriptive and analytic statistics were performed to report morbidity, mortality, and complication rates and to demonstrate associations between variables and outcomes. Logistic multivariable regression was performed to rule out confounding factors between subgroups.

Results

Thrombo-embolic complications occurred in 23/400 procedures (5.75%) and hemorrhagic complications in 19/400 procedures (4.75%). The majority of complications were minor and transient with overall procedure-related morbidity and mortality rates of 1.75% (n = 7/400) and 1.25% (n = 5/400) respectively. The co-existence of multiple cardiovascular risk factors among smoking, hypertension, dyslipidemia, and age > 65 years old was significantly associated with permanent procedure-related morbidity (p = 0.006) and thrombo-embolic complications occurrence (p = 0.034). Age alone was associated with higher permanent morbidity (p = 0.029) and was the only variable associated with higher hemorrhagic complication (p = 0.024).

Conclusion

In this study, the use of a high dosage antiplatelet premedication was safe and effective for the treatment of unruptured intracranial aneurysms with stent-assisted coiling or flow diverter stents. Mortality and morbidity rates compare favorably with the current literature. The thrombo-embolic complications rate is low and most of them were clinically silent. However, the hemorrhagic complications rate was substantial and a significant proportion of them were associated with mortality.

中文翻译：

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未破裂的颅内动脉瘤的抗血小板治疗方案的安全性和有效性：单中心经验。

目的

支架辅助的盘绕或分流支架对未破裂的颅内动脉瘤进行血管内治疗需要预防性抗血小板药物治疗，以避免血栓栓塞并发症。最佳抗血小板治疗方案的指南定义不明确。这项研究的目的是报告使用高剂量抗血小板预治疗方案的未破裂颅内动脉瘤患者接受支架辅助盘绕或分流支架进行血管内治疗的经验。

方法

通过对前瞻性维护数据库的回顾性分析，我们收集了362例接受419例颅内动脉瘤破裂的支架辅助卷绕或分流支架治疗的患者的400例手术的临床和血管造影数据。进行描述性和分析性统计以报告发病率，死亡率和并发症发生率，并证明变量与结果之间的关联。进行逻辑多变量回归以排除亚组之间的混杂因素。

结果

血栓栓塞并发症发生在23/400程序中（5.75％），出血并发症发生在19/400程序中（4.75％）。大多数并发症为轻度和短暂性，总体手术相关的发病率和死亡率分别为1.75％（n  = 7/400）和1.25％（n  = 5/400）。吸烟，高血压，血脂异常和年龄大于65岁的多种心血管危险因素的共存与永久性手术相关的发病率（p  = 0.006）和血栓栓塞并发症的发生（p  = 0.034）显着相关。单独的年龄与较高的永久性发病率相关（p  = 0.029），并且是与较高的出血并发症相关的唯一变量（p  = 0.024）。

结论

在这项研究中，使用大剂量抗血小板前药使用支架辅助盘绕或分流器支架治疗未破裂的颅内动脉瘤是安全有效的。死亡率和发病率与目前的文献相比具有优势。血栓栓塞并发症发生率低，大多数在临床上无声。但是，出血性并发症的发生率很高，其中很大一部分与死亡率有关。