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Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis.
- Source :
-
Journal of neurointerventional surgery [J Neurointerv Surg] 2022 Dec; Vol. 14 (12), pp. 1207-1212. Date of Electronic Publication: 2022 Jan 31. - Publication Year :
- 2022
-
Abstract
- Background: Endovascular embolization using standalone coils is the preferred treatment option for ruptured cerebral aneurysms to avoid the use of dual antiplatelet therapy with stent coiling or endoluminal flow diversion devices. However, it has been reported that patients undergoing the standalone coiling approach are at risk for periprocedural thromboembolism. Therefore, this systematic review and meta-analysis was performed to clarify the risks and benefits of antiplatelet therapy (AT) during coiling procedures performed to treat ruptured aneurysms, including the incidence of early thromboembolic events, hemorrhagic and delayed ischemic events, as well as clinical outcomes.<br />Methods: A comprehensive search of three databases was performed for articles from inception to June 2021. After fulfilling the inclusion criteria, five studies were included in this meta-analysis and 462 patients with aneurysmal subarachnoid hemorrhage (aSAH) were identified who underwent endovascular standalone coiling treatment. Aneurysm location, patient characteristics, and aSAH grades were comparable between the AT and non-AT groups.<br />Results: AT significantly decreased the incidence of thromboembolic events immediately after the coiling procedures compared with non-AT (OR 3.42; 95% CI 1.77 to 6.61, p<0.001). The incidences of hemorrhage, delayed ischemia, and clinical outcomes with or without AT were not significantly different between groups.<br />Conclusions: Although this study showed no beneficial effect of AT on clinical outcomes, the results suggest that AT could be combined with standalone coiling to avoid thromboembolism during the perioperative period. A large prospective study and/or an additional meta-analysis would be required to further investigate how AT benefits standalone coil embolization in aSAH.<br />Competing Interests: Competing interests: None declared.<br /> (© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.)
- Subjects :
- Humans
Platelet Aggregation Inhibitors therapeutic use
Prospective Studies
Stents adverse effects
Treatment Outcome
Retrospective Studies
Intracranial Aneurysm diagnostic imaging
Intracranial Aneurysm therapy
Intracranial Aneurysm complications
Aneurysm, Ruptured diagnostic imaging
Aneurysm, Ruptured therapy
Aneurysm, Ruptured complications
Embolization, Therapeutic methods
Subarachnoid Hemorrhage diagnostic imaging
Subarachnoid Hemorrhage therapy
Subarachnoid Hemorrhage complications
Endovascular Procedures methods
Thromboembolism etiology
Thromboembolism prevention & control
Thromboembolism drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1759-8486
- Volume :
- 14
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- Journal of neurointerventional surgery
- Publication Type :
- Academic Journal
- Accession number :
- 35101959
- Full Text :
- https://doi.org/10.1136/neurintsurg-2021-018346