Optimal duration of dual antiplatelet therapy after endovascular treatment of intracranial aneurysms with stenting: a systematic review and meta-analysis.

IF 2.6 3区医学 Q2 CLINICAL NEUROLOGY

Neuroradiology Pub Date : 2025-07-31 DOI:10.1007/s00234-025-03710-1

Anderson Matheus Pereira da Silva, Ocílio de Deus, Luciano Falcão, Mariana Lee Han, Filipe Virgilio Ribeiro, Pedro Lucas Machado Magalhães, Altair Melo Neto, Othon Trevisan Meira, Mariana Leticia Bastos Maximiano, Gustavo Sousa Noleto, Ahmet Günkan, Pascal M Jabbour

{"title":"Optimal duration of dual antiplatelet therapy after endovascular treatment of intracranial aneurysms with stenting: a systematic review and meta-analysis.","authors":"Anderson Matheus Pereira da Silva, Ocílio de Deus, Luciano Falcão, Mariana Lee Han, Filipe Virgilio Ribeiro, Pedro Lucas Machado Magalhães, Altair Melo Neto, Othon Trevisan Meira, Mariana Leticia Bastos Maximiano, Gustavo Sousa Noleto, Ahmet Günkan, Pascal M Jabbour","doi":"10.1007/s00234-025-03710-1","DOIUrl":null,"url":null,"abstract":"Background: The optimal duration of dual antiplatelet therapy (DAPT) following endovascular treatment of intracranial aneurysms remains uncertain. While DAPT effectively prevents thromboembolic complications, prolonged therapy may increase bleeding risk. This systematic review and meta-analysis compared the efficacy and safety of short-term versus long-term DAPT in patients undergoing endovascular treatment with stent-assisted coiling or flow diversion.Methods: We conducted a systematic review and meta-analysis according to PRISMA guidelines. Studies were identified through PubMed, Embase and Cochrane from inception to January 2025. Eligible studies included randomized controlled trials (RCTs) and observational cohorts comparing short-term DAPT (≤ 6 months) with long-term DAPT (> 6 months) in adults treated for intracranial aneurysms. Pooled risk ratio (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for observational studies.Results: Seven studies, comprising a total of 17,380 patients, were included, one RCT and six retrospective cohorts. The pooled analysis showed no significant difference in thromboembolic events between short- and long-term DAPT (RR: 1.18; 95% CI: 0.42-3.30; I2 = 60.5%). Short-term DAPT was associated with a lower risk of major bleeding (RR: 0.54; 95% CI: 0.32-0.91; I2 = 0%). No significant differences were observed between groups in retreatment (RR: 0.94; 95% CI: 0.24-3.62) or mortality (RR: 3.11; 95% CI: 0.96-10.09).Conclusions: Short-term DAPT demonstrates similar efficacy to long-term DAPT in preventing thromboembolic events and retreatment, with a lower incidence of major bleeding. These findings suggest that shorter DAPT regimens may offer a favorable safety profile. However, further large-scale RCTs are needed to establish definitive guidelines.","PeriodicalId":19422,"journal":{"name":"Neuroradiology","volume":" ","pages":""},"PeriodicalIF":2.6000,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Neuroradiology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1007/s00234-025-03710-1","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The optimal duration of dual antiplatelet therapy (DAPT) following endovascular treatment of intracranial aneurysms remains uncertain. While DAPT effectively prevents thromboembolic complications, prolonged therapy may increase bleeding risk. This systematic review and meta-analysis compared the efficacy and safety of short-term versus long-term DAPT in patients undergoing endovascular treatment with stent-assisted coiling or flow diversion.

Methods: We conducted a systematic review and meta-analysis according to PRISMA guidelines. Studies were identified through PubMed, Embase and Cochrane from inception to January 2025. Eligible studies included randomized controlled trials (RCTs) and observational cohorts comparing short-term DAPT (≤ 6 months) with long-term DAPT (> 6 months) in adults treated for intracranial aneurysms. Pooled risk ratio (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for observational studies.

Results: Seven studies, comprising a total of 17,380 patients, were included, one RCT and six retrospective cohorts. The pooled analysis showed no significant difference in thromboembolic events between short- and long-term DAPT (RR: 1.18; 95% CI: 0.42-3.30; I² = 60.5%). Short-term DAPT was associated with a lower risk of major bleeding (RR: 0.54; 95% CI: 0.32-0.91; I² = 0%). No significant differences were observed between groups in retreatment (RR: 0.94; 95% CI: 0.24-3.62) or mortality (RR: 3.11; 95% CI: 0.96-10.09).

Conclusions: Short-term DAPT demonstrates similar efficacy to long-term DAPT in preventing thromboembolic events and retreatment, with a lower incidence of major bleeding. These findings suggest that shorter DAPT regimens may offer a favorable safety profile. However, further large-scale RCTs are needed to establish definitive guidelines.

查看原文本刊更多论文

颅内动脉瘤血管内支架治疗后双重抗血小板治疗的最佳持续时间：一项系统回顾和荟萃分析。

背景：颅内动脉瘤血管内治疗后双重抗血小板治疗（DAPT）的最佳持续时间仍不确定。虽然DAPT可以有效预防血栓栓塞并发症，但长期治疗可能会增加出血风险。本系统综述和荟萃分析比较了短期与长期DAPT在接受血管内支架辅助盘绕或血流转移治疗的患者中的疗效和安全性。方法：我们根据PRISMA指南进行了系统回顾和荟萃分析。从开始到2025年1月，通过PubMed， Embase和Cochrane确定了研究。符合条件的研究包括随机对照试验（rct）和观察性队列，比较短期DAPT（≤6个月）和长期DAPT （bb0 6个月）在颅内动脉瘤治疗的成人中的应用。采用随机效应模型计算合并风险比（RR）和95%置信区间（CI）。rct采用rob2评估偏倚风险，观察性研究采用robins - 1评估偏倚风险。结果：纳入7项研究，共17380例患者，1项RCT和6项回顾性队列。合并分析显示，短期和长期DAPT在血栓栓塞事件方面无显著差异(RR: 1.18；95% ci: 0.42-3.30；i2 = 60.5%)。短期DAPT与较低的大出血风险相关(RR: 0.54；95% ci: 0.32-0.91；i2 = 0%)。再治疗组间无显著差异(RR: 0.94；95% CI: 0.24-3.62)或死亡率(RR: 3.11；95% ci: 0.96-10.09)。结论：短期DAPT与长期DAPT在预防血栓栓塞事件和再治疗方面的疗效相似，且大出血发生率较低。这些发现表明，较短的DAPT治疗方案可能具有良好的安全性。然而，需要进一步的大规模随机对照试验来建立明确的指导方针。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Neuroradiology 医学-核医学

CiteScore

5.30

自引率

3.60%

发文量

214

审稿时长

4-8 weeks

期刊介绍： Neuroradiology aims to provide state-of-the-art medical and scientific information in the fields of Neuroradiology, Neurosciences, Neurology, Psychiatry, Neurosurgery, and related medical specialities. Neuroradiology as the official Journal of the European Society of Neuroradiology receives submissions from all parts of the world and publishes peer-reviewed original research, comprehensive reviews, educational papers, opinion papers, and short reports on exceptional clinical observations and new technical developments in the field of Neuroimaging and Neurointervention. The journal has subsections for Diagnostic and Interventional Neuroradiology, Advanced Neuroimaging, Paediatric Neuroradiology, Head-Neck-ENT Radiology, Spine Neuroradiology, and for submissions from Japan. Neuroradiology aims to provide new knowledge about and insights into the function and pathology of the human nervous system that may help to better diagnose and treat nervous system diseases. Neuroradiology is a member of the Committee on Publication Ethics (COPE) and follows the COPE core practices. Neuroradiology prefers articles that are free of bias, self-critical regarding limitations, transparent and clear in describing study participants, methods, and statistics, and short in presenting results. Before peer-review all submissions are automatically checked by iThenticate to assess for potential overlap in prior publication.