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    • Association of Preprocedural Antiplatelet Use with Decreased Thromboembolic Complications for Intracranial Aneurysms Undergoing Intrasaccular Flow Disruption.

    Journal of neurosurgery（2024）

    Univ Toronto | Louisiana State Univ | 1Division of Diagnostic and Therapeutic Neuroradiology | Harvard Univ | Ankara Univ | Mayo Clin | Hop Purpan | Hop Univ Erasme | Osped Careggi Firenze | 9Neurosurgery & Interventional Neuroradiology | CHU Vaudois | Thomas Jefferson Univ | Univ Sorbonne | Univ Klinikum Heidelberg | Paracelsus Med Univ | NYU Langone Hlth Ctr | Univ Penn | Clin Sagrada Familia | Orlando Hlth Neurosci & Rehabil Inst | Rowan Univ | Clin Hosp Ctr Sisters Mercy | UTMB | Baylor Coll Med | SUNY Buffalo | Minist Hlth | Austin Hlth | Geisinger Hosp | Osped Niguarda Ca Granda | UMass Mem Hosp | Osped San Raffaele | Univ Miami | Valley Baptist Neurosci Inst | Univ Alabama Birmingham | Univ Hosp Basel | Univ Med Ctr Hamburg Eppendorf | Univ Texas Hlth Sci Ctr Houston | Montefiore Med Ctr

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    Abstract
    OBJECTIVE This study was conducted to investigate the impact of antiplatelet administration in the periprocedural period on the occurrence of thromboembolic complications (TECs) in patients undergoing treatment using the Woven EndoBridge (WEB) device for intracranial wide-necked bifurcation aneurysms. The primary objective was to assess whether the use of antiplatelets in the pre- and postprocedural phases reduces the likelihood of developing TECs, considering various covariates. METHODS A retrospective multicenter observational study was conducted within the WorldWideWEB Consortium and comprised 38 academic centers with endovascular treatment capabilities. Univariable and multivariable logistic regression analyses were performed to determine the association between antiplatelet use and TECs, adjusting for covariates. Missing predictor data were addressed using multiple imputation. RESULTS The study comprised two cohorts: one addressing general thromboembolic events and consisting of 1412 patients, among whom 103 experienced TECs, and another focusing on symptomatic thromboembolic events and comprising 1395 patients, of whom 50 experienced symptomatic TECs. Preprocedural antiplatelet use was associated with a reduced likelihood of overall TECs (OR 0.32, 95% CI 0.19-0.53, p < 0.001) and symptomatic TECs (OR 0.49, 95% CI 0.25-0.95, p = 0.036), whereas postprocedural antiplatelet use showed no significant association with TECs. The study also revealed additional predictors of TECs, including stent use (overall: OR 4.96, 95% CI 2.38-10.3, p < 0.001; symptomatic: OR 3.24, 95% CI 1.26-8.36, p = 0.015), WEB single-layer sphere (SLS) type (overall: OR 0.18, 95% CI 0.04-0.74, p = 0.017), and posterior circulation aneurysm location (symptomatic: OR 18.43, 95% CI 1.48-230, p = 0.024). CONCLUSIONS The findings of this study suggest that the preprocedural administration of antiplatelets is associated with a reduced likelihood of TECs in patients undergoing treatment with the WEB device for wide-necked bifurcation aneurysms. However, postprocedural antiplatelet use did not show a significant impact on TEC occurrence.
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    aneurysms,intracranial,WEB,Woven EndoBridge,treatment,vascular disorders
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    【要点】：该论文研究了围手术期使用抗血小板药物对接受Woven EndoBridge (WEB)装置治疗的宽颈分叉型脑动脉瘤患者血栓栓塞并发症发生率的影响，发现术前使用抗血小板药物与降低血栓栓塞并发症的发生率有关。
    

    【方法】：研究者进行了一项回顾性的多中心观察性研究，包括38个具有血管内治疗能力的学术中心，运用单变量和多变量逻辑回归分析评估围手术期使用抗血小板与血栓栓塞并发症之间的关系，并调整了各种协变量。
    

    【实验】：研究包含了两个队列，一个关注一般血栓栓塞事件，共1412名患者，其中103名出现血栓栓塞并发症；另一个关注症状性血栓栓塞事件，共1395名患者，其中50名出现症状性血栓栓塞并发症。结果显示，术前使用抗血小板药物与降低总体和症状性血栓栓塞并发症的发生率有关，而术后使用抗血小板药物则未显示出对血栓栓塞并发症有显著影响。此外，研究还揭示了其他与血栓栓塞并发症有关的预测因素，包括支架使用、WEB单层球体(SLS)类型和后循环动脉瘤位置。