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.
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.
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.
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.
Data availability statement
All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.
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HT and JT are joint first authors.
Contributors Conception and design: HT and JT. Literature search and data analysis: HT, JT, KT, and MS. Summarized the included studies: HT, JT, MS, and J-KB. PROSPERO registration: YN and HT. Drafted and/or critically revised the work: HT, MS, and J-KB. Revised the manuscript: all authors. Funding acquisition: HT. Final approval of manuscript: HT. Guarantor: HT
Funding This work was supported in part by Japan Society for the Promotion of Science 'KAKENHI' (20K09330) (HT) and Taiju Life Social Welfare Foundation (HT).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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