Antiplatelet therapy for standalone coiling of ruptured intracranial aneurysms: a systematic review and meta-analysis

Abstract

BackgroundEndovascular 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.MethodsA 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.ResultsAT 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.ConclusionsAlthough 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.

Network Meta-analysis of C5 Palsy after Anterior Cervical Decompression of 3-6 Levels

“…Furthermore, all 3 comparisons were primarily based on direct evidence (Figure 3C, Supplemental Figure 1C, Supplemental Digital Content 1, http://links.lww.com/BRS/C286, 2B, Supplemental Digital Content 2, http://links.lww.com/BRS/C287), although 10 of the 11 included studies were retrospective. The careful inclusion of non-RCT studies may provide useful, comprehensive, and generalizable evidence regarding the comparative safety and effectiveness of treatments 46–48 …”

“…The careful inclusion of non-RCT studies may provide useful, comprehensive, and generalizable evidence regarding the comparative safety and effectiveness of treatments. [46][47][48] We acknowledge several limitations. Foremost, this remains a literature review and despite adhering to guidelines, we may have failed to include some potentially eligible studies.…”

Neurosurgical clipping vs spiral management in ruptured brain aneurysm. A systematic review

“…Una revisión sistemática y metaanálisis demostró que la terapia antitrombótica disminuyó significativamente la incidencia de eventos tromboembólicos, inmediatamente después de los procedimientos de espiral en comparación con los que no recibieron terapia antitrombótica (p <0,001), se define como fracaso al tratamiento, la presencia de hemorragia intracraneal, durante el seguimiento o aneurisma residual al año (34).…”