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Neurosurgical review
Jun 02, 2023;46 (1): 133.

Does dual antiplatelet therapy increase the risk of haematoma enlargement in the acute stage? A retrospective study of the use of stent-assisted coiling versus coiling alone or balloon-assisted coiling for the treatment of ruptured intracranial aneurysms combined with intracranial haematoma.

Ruoxi Cheng, Kangtai Su, Xiaobing Zhou, Xin Jiang, Peiyi Luo, Weiyun Zhang, Xiao Qian, Lingfeng Lai
Author Information
  1. Ruoxi Cheng: Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
  2. Kangtai Su: The First Clinical Medical School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
  3. Xiaobing Zhou: Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
  4. Xin Jiang: Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
  5. Peiyi Luo: Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
  6. Weiyun Zhang: Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
  7. Xiao Qian: Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China.
  8. Lingfeng Lai: Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China. laiweiwei1986@163.com.
PMID: 37266675 DOI: 10.1007/s10143-023-02036-x

Abstract

This study aims to identify the efficacy and safety of stent-assisted coiling (SAC) treatment of ruptured intracranial aneurysms (RIAs) combined with intracranial haematoma (ICH) compared to coiling alone or balloon-assisted coiling (non-SAC). A retrospective analysis of 54 consecutive patients receiving endovascular therapy from 2014 to 2020 was performed. The data collected included baseline characteristics, angiographic results, perioperative complications, immediate aneurysm occlusion, clinical outcomes, follow-up at discharge and after 6 months, hospitalisation costs, and inpatient length of stay. Patients were categorised into the SAC group and the non-SAC group. Univariate and multivariate logistic regression analyses were used to identify risk factors related to clinical outcomes. Of the 54 patients harbouring RIAs with ICH, 22 (40.74%) and 32 (59.26%) patients were subject to SAC and non-SAC treatments, respectively. Postoperative rebleeding (1 [4.5%] and 3 [9.3%] in SAC and non-SAC groups, respectively, p > 0.05) and Hunt-Hess grade (IV-V) lesions (13.6% vs. 40.6%, p = 0.067) did not differ between the two groups. In total, 10 (45.5%) patients treated with SAC received a Fisher scale score of 0-3 compared with 6 (18.8%) patients treated with non-SAC methods (p = 0.035). Compared with the non-SAC group (7/21.9%), the rate of wide-necked aneurysms was increased in the SAC group (11/50%) (p = 0.031). No differences in poor outcomes (mRS > 2) were noted between the SAC and non-SAC groups (p > 0.05). Multivariate analysis revealed that ischaemic complication events (p = 0.016) represent the only independent risk factor for adverse outcomes, and a trend towards unfavourable clinical outcomes was noted for patients who smoke (p = 0.087). SAC is a safe and efficient treatment for RIAs combined with ICH when dual antiplatelet therapy (DAPT) is used in the perioperative period. In addition, SAC should be preferentially used in wide-neck RIAs. Ischaemic complications are a risk factor for poor clinical outcomes. Given the small sample size and retrospective bias of this study, these findings should be further verified in a study with a larger sample size or a randomised controlled trial (RCT).

Keywords

Dual antiplatelet Intracranial haematoma Ruptured intracranial aneurysm Safety and efficacy Stent-assisted coiling

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Grants

  1. 20195115/Health Commission of Jiangxi Province
  2. 20195115/Health Commission of Jiangxi Province
  3. 20195115/Health Commission of Jiangxi Province
  4. 20195115/Health Commission of Jiangxi Province
  5. 20195115/Health Commission of Jiangxi Province
  6. 20195115/Health Commission of Jiangxi Province
  7. 20195115/Health Commission of Jiangxi Province
  8. 20195115/Health Commission of Jiangxi Province
  9. 20192BAB215024/Natural Science Foundation of Jiangxi Province
  10. 20192BAB215024/Natural Science Foundation of Jiangxi Province
  11. 20192BAB215024/Natural Science Foundation of Jiangxi Province
  12. 20192BAB215024/Natural Science Foundation of Jiangxi Province
  13. 20192BAB215024/Natural Science Foundation of Jiangxi Province
  14. 20192BAB215024/Natural Science Foundation of Jiangxi Province
  15. 20192BAB215024/Natural Science Foundation of Jiangxi Province
  16. 20192BAB215024/Natural Science Foundation of Jiangxi Province

MeSH Term

Humans
Aneurysm, Ruptured
Cerebral Angiography
Cerebral Hemorrhage
Embolization, Therapeutic
Endovascular Procedures
Hematoma
Intracranial Aneurysm
Platelet Aggregation Inhibitors
Retrospective Studies
Stents
Treatment Outcome

Chemicals

Platelet Aggregation Inhibitors
Comparative Study Journal Article

Word Cloud

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