- 作者：Yoshihisa Matsumoto ; MD&lowast ; ; Kanji Nakai ; MD ; PhD&dagger ; ; nakai@sb3.so-net.ne.jp" class="auth_mail ; Masanori Tsutsumi ; MD ; PhD&dagger ; ; Minoru Iko ; MD ; PhD&dagger ; ; Kouhei Nii ; MD ; PhD&Dagger ; ; Sumito Narita ; MD&dagger ; ; Ayumu Eto ; MD&dagger ; ; Takahumi Mitsutake ; MD&dagger ; ; Hiroshi Aikawa ; MD ; PhD&dagger ; ; Kiyoshi Kazekawa ; MD ; PhD&dagger ;
- 关键词：Intracranial aneurysm ; stent-assisted coil embolization ; ischemic event ; antiplatelet therapy
- 刊名：Journal of Stroke and Cerebrovascular Diseases
- 出版年：April, 2014
- 年：2014
- 卷：23
- 期：4
- 页码：771-777
- 全文大小：185 K
Background
Stent-assisted coil embolization is effective for intracranial aneurysms, especially wide-necked aneurysms; however, the optimal antiplatelet regimens for ischemic events that develop after coil embolization have not yet been established. We aimed to determine the onset time of such postoperative ischemic events and the relationship between these events and antiplatelet therapy.Methods
We performed coil embolization using a vascular reconstruction stent for 43 cases of intracranial aneurysms and evaluated the incidence of postoperative ischemic events in these cases.
Results
Nine patients showed postoperative ischemic events during the follow-up period (13聽卤聽7聽months). Two patients developed cerebral infarction within 24聽hours. Five patients developed transient ischemic attack within 40聽days while they were receiving dual antiplatelet therapy. In addition, 1 patient showed cerebral infarction 143聽days postoperatively during single antiplatelet therapy, and a case of transient visual disturbance was reported 191聽days postoperatively (49聽days after antiplatelet therapy had been discontinued). We increased the number of antiplatelet agents in 4 of these patients. The other 5 patients were under strict observation with dual antiplatelet therapy. All these patients were shifted to single antiplatelet therapy 3-13聽months postoperatively. No recurrence of ischemic events was noted.
Conclusions
Postoperative ischemic events are most likely to occur within 40聽days postoperatively. For patients with postoperative ischemic events, additional ischemic events can be prevented by increasing the number of antiplatelet agents; subsequently, they can be shifted to single antiplatelet therapy after the risk of recurrence has decreased.