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Vascular neurology
Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis
  1. Hajime Takase1,2,
  2. Junya Tatezuki3,
  3. Mohamed M Salem4,
  4. Katsuko Tayama5,
  5. Yoshihiko Nakamura6,
  6. Jan-Karl Burkhardt4,
  7. Tetsuya Yamamoto1
  1. 1Department of Neurosurgery, Yokohama City University, Yokohama, Kanagawa, Japan
  2. 2Center for Novel and Exploratory Clinical Trials (Y-NEXT), Yokohama City University, Yokohama, Kanagawa, Japan
  3. 3Department of Neurosurgery, Yokohama City Minato Red Cross Hospital, Yokohama, Kanagawa, Japan
  4. 4Department of Neurosurgery, Hospital of the University of Pennsylvania, Penn Medicine, Philadelphia, Pennsylvania, USA
  5. 5Department of Management, Tokyo University of Science, Shinjuku-ku, Tokyo, Japan
  6. 6Department of Emergency and Critical Care Medicine, Fukuoka University Hospital, Fukuoka, Japan
  1. Correspondence to Dr Hajime Takase, Department of Neurosurgery, Yokohama City University 3-9 Fukuura, Kanazawa-ku, Yokohama, Kanagawa 236-0004, Japan; htakase{at}yokohama-cu.ac.jp

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.

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.

  • aneurysm
  • coil
  • complication
  • hemorrhage
  • platelets

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information. Not applicable.

https://doi.org/10.1136/neurintsurg-2021-018346

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    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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    Footnotes

    • 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.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.