دورية أكاديمية
Antiplatelet therapy for the prevention of peri-coiling thromboembolism in high-risk patients with ruptured intracranial aneurysms.
| العنوان: | Antiplatelet therapy for the prevention of peri-coiling thromboembolism in high-risk patients with ruptured intracranial aneurysms. |
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| المؤلفون: | Edwards NJ; Departments of1Neurosurgery and.; 2Neurology, University of Texas Health Science Center at Houston, Texas., Jones WH; Departments of1Neurosurgery and., Sanzgiri A; Departments of1Neurosurgery and., Corona J; Departments of1Neurosurgery and., Dannenbaum M; Departments of1Neurosurgery and., Chen PR; Departments of1Neurosurgery and. |
| المصدر: | Journal of neurosurgery [J Neurosurg] 2017 Dec; Vol. 127 (6), pp. 1326-1332. Date of Electronic Publication: 2017 Jan 06. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: American Association of Neurological Surgeons Country of Publication: United States NLM ID: 0253357 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1933-0693 (Electronic) Linking ISSN: 00223085 NLM ISO Abbreviation: J Neurosurg |
| أسماء مطبوعة: | Publication: Charlottesville, VA : American Association of Neurological Surgeons Original Publication: Chicago [etc.] |
| مواضيع طبية MeSH: | Aneurysm, Ruptured/*complications , Aspirin/*therapeutic use , Intracranial Aneurysm/*complications , Platelet Aggregation Inhibitors/*therapeutic use , Thromboembolism/*prevention & control, Adult ; Aged ; Aneurysm, Ruptured/diagnostic imaging ; Cerebral Angiography ; Female ; Humans ; Intracranial Aneurysm/diagnostic imaging ; Male ; Middle Aged ; Registries ; Retrospective Studies ; Thromboembolism/diagnostic imaging ; Thromboembolism/etiology ; Treatment Outcome |
| مستخلص: | OBJECTIVE The most frequent procedural complication of the endovascular treatment of intracranial aneurysms is a thromboembolic event (TEE); in a subset of patients, such events will cause permanent neurological disability. In patients with unruptured aneurysms, increasing evidence supports the use of periprocedural antiplatelet therapy to prevent TEEs. The object of this study was to evaluate whether patients with ruptured aneurysms and subarachnoid hemorrhage would also benefit from periprocedural antiplatelet therapy. METHODS The authors reviewed a prospective registry of 169 patients with endovascularly treated intracranial aneurysms to delineate angiographic features associated with periprocedural TEEs. They then performed a controlled before-and-after study in 79 patients with ruptured aneurysms who were deemed to be at high risk for TEEs (for example, patients with at least 1 angiographic feature associated with TEEs) to evaluate whether selective aspirin administration would reduce the rate of periprocedural thromboembolism without increasing major hemorrhagic complications. RESULTS Six angiographic features were associated with periprocedural TEEs in the study cohort: wide aneurysm neck, coil or loop protrusion, small parent artery diameter, an incorporated branch, intraprocedural thrombus formation, and intracranial parent vessel atherosclerosis. Aspirin administration to high-risk patients significantly decreased the rate of periprocedural TEEs, from 53.8% in the control group to 10.6% in the aspirin-treated group (p = 0.001). The reduction in TEEs in the aspirin-treated group continued to be statistically significant even when adjusted for age, sex, cardiovascular risk factors (smoking, diabetes, hypertension, dyslipidemia, coronary artery disease), and factors associated with TEEs in other large studies (wide aneurysm neck, aneurysm size ≥ 10 mm), with an adjusted OR of 0.16 (95% CI 0.03-0.8). There were no major systemic hemorrhagic complications, and aspirin did not increase the risk of aneurysm rebleeding, symptomatic intracranial hemorrhage, or major external ventricular drain (EVD)-associated hemorrhage (p = 0.3), though there was an increase in asymptomatic, minor (< 1 cm) EVD-associated hemorrhage in the aspirin-treated group (p = 0.02). CONCLUSIONS The study findings suggest that for ruptured aneurysm patients with high-risk features, antiplatelet therapy can significantly reduce the rate of periprocedural TEE without increasing major systemic or intracranial hemorrhages. |
| فهرسة مساهمة: | Keywords: ASA = acetylsalicylic acid (aspirin); EVD = external ventricular drain; HH = Hunt and Hess; HTPR = high on-treatment platelet reactivity; ICH = intracranial hemorrhage; TEE = thromboembolic event; TIMI = Thrombolysis In Myocardial Infarction; aSAH = aneurysmal subarachnoid hemorrhage; coiling; ruptured aneurysms; thromboembolic events; vascular disorders |
| المشرفين على المادة: | 0 (Platelet Aggregation Inhibitors) R16CO5Y76E (Aspirin) |
| تواريخ الأحداث: | Date Created: 20170107 Date Completed: 20190814 Latest Revision: 20190814 |
| رمز التحديث: | 20221213 |
| DOI: | 10.3171/2016.9.JNS161340 |
| PMID: | 28059659 |
| قاعدة البيانات: | MEDLINE |
| تدمد: | 1933-0693 |
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| DOI: | 10.3171/2016.9.JNS161340 |