Delayed ischemic stroke after PED placement for aneurysms: optimal duration of dual antiplatelet therapy and risk factors.

IF 2.7 3区医学 Q2 CLINICAL NEUROLOGY

Frontiers in Neurology Pub Date : 2025-04-22 eCollection Date: 2025-01-01 DOI:10.3389/fneur.2025.1561965

Chao Wang, Yangyang Zhou, Ying Zhang, Dachao Wei, Mirzat Turhon, Jian Liu, Yisen Zhang, Kun Wang, Hongqi Zhang, Tianxiao Li, Aisha Maimaitili, Guohua Mao, Donglei Song, Yunyan Wang, Wenfeng Feng, Yang Wang, Huaizhang Shi, Jieqing Wan, Jianmin Liu, Sheng Guan, Yuanli Zhao, Wenqiang Li, Xinjian Yang

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引用次数: 0

Abstract

Background: Delayed ischemic stroke (DIS) is a rare complication that may occur in patients with cerebral aneurysms treated with the Pipeline Embolization device (PED). This study aims to evaluate the characteristics of DIS following PED placement and to investigate the optimal duration of dual antiplatelet therapy (DAPT) in relation to the incidence of DIS.

Methods: We conducted a multicenter retrospective cohort study on consecutive cases of intracranial aneurysms treated with PED. Patients were divided into two groups based on the timing of DAPT switching to monotherapy: early (<6 months) and late (≥6 months). To adjust for potential biases between the groups, inverse probability of treatment weighting (IPTW) was applied. Kaplan-Meier survival analysis and multivariate Cox regression were used to calculate cumulative DIS rates, and risk factors for DIS.

Results: A total of 1,146 consecutive patients with 1,296 aneurysms were included, of whom 12 (0.96%) who received PED developed DIS. The late-switch group had a lower DIS rate compared to the early-switch group [0.5% (4 of 752 patients) vs. 2.0% (8 of 394 patients), p = 0.018], even after IPTW. Hypertension [hazard ratio (HR) 3.47, 95% CI: 1.045-11.552] and complete occlusion immediately post-procedure (HR 5.48, 95% CI: 3.048-9.868) were significant risk factors for DIS.

Conclusion: DIS is a rare complication among patients treated with PED for cerebral aneurysms. Extending the duration of DAPT to at least six months may safer for the patients with hypertension and immediate complete occlusion.

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动脉瘤植入PED后迟发性缺血性卒中：双重抗血小板治疗的最佳持续时间和危险因素。

背景：迟发性缺血性脑卒中（DIS）是一种罕见的并发症，可能发生在使用管道栓塞装置（PED）治疗的脑动脉瘤患者中。本研究旨在评价PED放置后DIS的特点，并探讨双重抗血小板治疗（DAPT）的最佳持续时间与DIS发生率的关系。方法：我们对连续使用PED治疗的颅内动脉瘤病例进行了多中心回顾性队列研究。根据DAPT切换到单药治疗的时间将患者分为两组：早期(结果：共纳入1,146例连续患者1,296个动脉瘤，其中12例（0.96%）接受PED的患者发生了DIS。即使在IPTW后，晚切换组的DIS率也低于早切换组[0.5%（752例患者中4例）vs. 2.0%（394例患者中8例），p = 0.018]。高血压[危险比（HR） 3.47, 95% CI: 1.045-11.552]和术后立即完全闭塞（HR 5.48, 95% CI: 3.048-9.868）是脑动脉瘤PED患者发生DIS的重要危险因素。延长DAPT持续时间至至少6个月对于高血压和立即完全闭塞的患者可能更安全。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Frontiers in Neurology CLINICAL NEUROLOGYNEUROSCIENCES -NEUROSCIENCES

CiteScore

4.90

自引率

8.80%

发文量

2792

审稿时长

14 weeks

期刊介绍： The section Stroke aims to quickly and accurately publish important experimental, translational and clinical studies, and reviews that contribute to the knowledge of stroke, its causes, manifestations, diagnosis, and management.