Abstract TP88: Tailored Periprocedural Antiplatelet Therapy for Coil Embolization of Unruptured Intracranial Aneurysms using Neck Size

Abstract

Introduction and Hypothesis: Although periprocedural antiplatelet therapy (APT) for coil embolization of unruptured aneurysms (UAs) has been prevailing, its detailed regimens such as mode (single or dual), dose, and duration, are not yet well established. Recently, we have reported our retrospective data that dual APT better prevented ischemic complications from coiling in wide-necked aneurysms compared with single APT. The aim of this prospective study is to assess the efficacy of using the aneurysmal neck width to determine the mode of APT (single or dual) for coiling of UAs, especially focusing on the safety of single APT for narrow-necked aneurysms in prevention of ischemic complications. Methods: A total of 78 consecutive patients harboring UAs treated by endosaccular coil embolization at our institute between September 2009 and July 2012 were included. Stent-assisted cases were excluded. APT was started 4 days prior to the procedure, and UAs with narrow neck (<4mm, 24 cases) received single APT (aspirin 100mg; group 1) while wide-necked cases (≥4mm, 54 cases) received dual APT (aspirin 100mg and clopidogrel 75mg ) were administered for one month. The incidence of both ischemic and hemorrhagic complications, and abnormality in postprocedural diffusion weighted imaging (DWI) in each group was assessed. Results: Symptomatic ischemic complications occurred in 3 (5.5%) cases in group 2 and none in group 1. DWI abnormalities were observed in 5 (20.8 %) in group 1 and 20 (37.0%) in group 2. In cases with adjunctive technique, there was no significant difference in the incidence of DWI positive cases between group 1 (3/13, 23.1%) and 2 (19/49, 38.8%) (P=0.16). Hemorrhagic complicationoccurred in only one case in group 2 (1.9%). Conclusions: In this series, single APT for coiling of narrow-necked aneurysms well prevented both periprocedural ischemic events and DWI positive lesions. In conclusion, this protocol, which determines the mode of APT by neck size, seems easy to use and could be beneficial in prevention of ischemic/hemorrhagic complications and from medico-financial aspect.