The Indication for Long-Term Oral Antiplatelet Therapy After Endovascular Embolization of Unruptured Intracranial Aneurysms

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Background: Antiplatelet therapy (APT) is indispensable to prevent ischemic complications of unruptured intracranial aneurysms (UICAs); however, long-term APT can cause hemorrhagic complications. We evaluated the rates of use and factors for long-term APT in patients who underwent endovascular embolization of UICA. Methods: A total of 175 UICAs in 169 patients were studied. Dual APT was initiated, pre-operatively. Embolization of the UICAs was achieved with four different endovascular methods: single/double catheter (41% of the cases), balloon-assisted (50%), stent-assisted (9%), and internal trapping (2%). Single APT was utilized for 1 - 3 months in patients who were not treated with a stent. In patients who were treated with the stent-assisted method, dual APT was continued for 3 - 6 months, with transition to single APT. Results: The rates of pre-operative APT were 13%, 87%, and 0.6% in the single, dual, and triple APT therapy groups, respectively. APT was necessary for over 1 year in 18% of patients; 11% of the patients needed long-term PT because of aneurysm-specific factors (20 cases: stent placement, 16; stenosis of the branch artery of the aneurysm, one; coil protrusion to the parent artery, two; coil migration, one), and the indication was patient-specific for 7% (nine cases: coronary artery disease, five; cerebral artery disease, four). Delayed ischemic events occurred in 1.1% (two cases); one cerebral infarction was associated with stent-assisted embolization and one occurred due to stenosis of the branching artery. Conclusions: The most common indication for long-term APT was stent placement. Stenosis of the branch artery of the aneurysm, coil protrusion into the parent artery, and coil migration were the other reasons for long-term APT. The use of stents should be limited to the management of wide-neck or large aneurysms to prevent delayed ischemic and hemorrhagic complications. J Neurol Res. 2016;6(4):72-80 doi: http://dx.doi.org/10.14740/jnr390w