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":"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。","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":"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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; I<sup>2</sup> = 60.5%). Short-term DAPT was associated with a lower risk of major bleeding (RR: 0.54; 95% CI: 0.32-0.91; I<sup>2</sup> = 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).</p><p><strong>Conclusions: </strong>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.</p>","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":"{\"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\":\"<p><strong>Background: </strong>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.</p><p><strong>Methods: </strong>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.</p><p><strong>Results: </strong>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; I<sup>2</sup> = 60.5%). Short-term DAPT was associated with a lower risk of major bleeding (RR: 0.54; 95% CI: 0.32-0.91; I<sup>2</sup> = 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).</p><p><strong>Conclusions: </strong>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.</p>\",\"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}","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}
Optimal duration of dual antiplatelet therapy after endovascular treatment of intracranial aneurysms with stenting: a systematic review and meta-analysis.
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.
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.
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