颗粒、液体和抗血小板：干预后第3天或更晚重新启动抗血小板与颗粒栓塞后预后改善相关。

IF 3.9 2区医学 Q1 CLINICAL NEUROLOGY

Neurosurgery Pub Date : 2025-04-03 DOI:10.1227/neu.0000000000003440

Pious D Patel, Sanjana Salwi, Georgios Sioutas, Jean Filo, Mohamed F Doheim, Alexandra Diamond, Mohamed Salem, Li Ma, Samer S Hoz, Abdullah Sultany, Raul G Nogueira, Alhamza R Al-Bayati, Michael J Lang, M Reid Gooch, Stavropoula Tjoumakaris, Christopher S Ogilvy, Robert H Rosenwasser, Jan-Karl Burkhardt, Pascal Jabbour, Visish M Srinivasan

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引用次数: 0

摘要

背景与目的：慢性硬膜下血肿（cSDH）脑膜中动脉栓塞（MMAE）后重新启动抗血小板药物的时机是一个有争议的话题。本研究的目的是确定cSDH MMAE后抗血小板重新启动的时机是否影响长期影像学和临床结果。方法：采用2018年至2023年4个学术医疗中心对cSDH进行MMAE治疗的数据进行多机构回顾性队列研究。在纳入MMAE之前，患者被处方抗血小板药物。变量包括人口统计学、合并症、手术时间和抗血小板重启、基线修正兰金量表、SDH初始大小和使用的栓塞材料。结果是短期（2周）和长期（6周）随访时的SDH厚度，90天时的非计划手术撤离需求和修改的Rankin量表。结果：128例患者中（78%为男性，中位年龄76岁[IQR 70-83]），干预后67例（52%）患者重新使用抗血小板药物。未重新使用抗血小板药物的患者死亡率更高（20% vs 5%, P = 0.038）。在干预后重新使用抗血小板药物的患者中，抗血小板重新启动时间与长期SDH大小变化之间存在显著相关（R = -0.43, P = 0.025）。干预后第3天或更晚的抗血小板重启与长期SDH厚度的改善相关（β = -5.7 mm, s.e 2.5, P = 0.034）。颗粒栓塞亚组观察到这种效果（β = -8.3 mm, s.e. 3.2, P = 0.021），但液体栓塞亚组没有观察到这种效果（β = 1.7 mm, s.e. 5.5, P = .773）。结论：cSDH MMAE后未重新使用抗血小板药物的患者死亡率更高，功能独立性降低。在重新启动抗血小板治疗的患者中，干预后第3天或更晚的重新启动日期与长期SDH大小的显著降低相关。

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Particles, Liquids, and Antiplatelets: Restarting Antiplatelets on Postintervention Day 3 or Later is Associated with Improved Outcomes After Particle Embolization.

Background and objectives: Timing of restarting antiplatelet agents after middle meningeal artery embolization (MMAE) for chronic subdural hematoma (cSDH) is a topic of controversy. The aim of this study was to determine whether the timing of antiplatelet restart after MMAE for cSDH affects long-term radiographic and clinical outcomes.

Methods: A multi-institutional, retrospective cohort study was performed using data from 4 academic medical centers that performed MMAE for cSDH from 2018 to 2023. Patients were prescribed an antiplatelet agent before MMAE were included. Variables included demographics, comorbidities, timing of the procedure and antiplatelet restart, baseline modified Rankin Scale, initial size of SDH, and embolic material used. Outcomes were thickness of SDH at short-term (2 weeks) and long-term (6 weeks) follow-ups, need for unplanned surgical evacuation, and modified Rankin Scale at 90 days.

Results: Of 128 patients (78% male, median age 76 years [IQR 70-83]), 67 patients (52%) had their antiplatelet agent restarted postintervention. Patients who did not have their antiplatelet agent restarted experienced higher mortality (20% vs 5%, P = .038). Among patients with antiplatelet agent restarted postintervention, there was a significant correlation (R = -0.43, P = .025) between timing of antiplatelet restart and long-term SDH size change. Antiplatelet restart on postintervention day 3 or later was associated with improvement in long-term SDH thickness (β = -5.7 mm, s.e. 2.5, P = .034). This effect was observed in the particle-embolization subgroup (β = -8.3 mm, s.e. 3.2, P = .021), but not the liquid-embolization subgroup (β = 1.7 mm, s.e. 5.5, P = .773).

Conclusion: There was a higher rate of mortality and decreased functional independence among patients who did not have their antiplatelet agent restarted after MMAE for cSDH. Among patients who did have their antiplatelet restarted, a restart date of postintervention day 3 or later was associated with a significant decrease in long-term SDH size.

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来源期刊

Neurosurgery 医学-临床神经学

CiteScore

8.20

自引率

6.20%

发文量

898

审稿时长

2-4 weeks

期刊介绍： Neurosurgery, the official journal of the Congress of Neurological Surgeons, publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology, and medicine. For professionals aware of the rapid pace of developments in the field, this journal is nothing short of indispensable as the most complete window on the contemporary field of neurosurgery. Neurosurgery is the fastest-growing journal in the field, with a worldwide reputation for reliable coverage delivered with a fresh and dynamic outlook.