Enterprise Stent-assisted Cerebral Aneurysm Coiling: Can Antiplatelet Therapy be Terminated after Neointima Formation with the Enterprise Stent?

Abstract

Objective: Patients who undergo Enterprise stent (ES)-assisted cerebral aneurysm coiling require long-term antiplatelet therapy (AT). Some studies have reported that cessation or modification of AT increases the risk of cerebral infarction.The aim of this study was to evaluate whether AT can terminated without increasing the risk of ischemic events among patients who have undergone ES-assisted cerebral aneurysm coiling. Methods:This study evaluated 9 with 11 unruptured aneurysms were confirmed to have neointima formation with the ES on follow-up angiography. Dual AT was given for ≥3 months postoperatively, then one antiplatelet agent was administered until ≥6 months postoperatively before termination of all AT. Incidences of ipsilateral ischemic events and stent occlusion after AT termination were assessed prospectively.Results: During follow-up (mean, 32.8 months; range, 21.5-51.3 months) ipsilateral ischemic events and stent occlusion did not occur in any cases. Conclusion:Termination of AT ≥6 months postoperatively did not result in ischemic events among patients with neointima formation after ES-assisted cerebral aneurysm coiling.

Discontinuation of antiplatelet therapy after stent-assisted coil embolisation of cerebral aneurysm: a nationwide cohort study

“…Neurointerventionalists generally agree that the use of APT after SACE does not need to be lifelong. [8][9][10][11][12][13] A French national survey revealed that only 16% of centres prescribed lifelong APT after SACE. 13 Complete endothelialisation of the stent reduces the need for lifelong APT by ensuring a living, non-thrombogenic surface within the lumen of the parent artery and eliminating direct stentblood flow contact.…”

“…27 Although previous retrospective studies predominantly relied on descriptive results, they proposed diverse regional protocols (3-24 months) for the safe timing for discontinuation of APT after SACE. [8][9][10][11][12] All of these protocols emphasised the selection of patients with a low risk of ischaemia and documented complete neointimalisation of the parent artery. [8][9][10][11][12] In line with the previous studies, our study findings suggest that APT benefits cerebral infarction prevention until 1 year after SACE, [8][9][10][11][12][13] making it a reasonable strategy to consider discontinuing APT at that time.…”

“…Stent implantation in normal arteries, as opposed to atherosclerotic arteries, might carry a lower risk of thromboembolic events and require a less invasive APT strategy. Based on the aforementioned assumption, several clinicians advocate the discontinuation of APT 3-36 months after SACE in clinical practice [8][9][10][11][12] ; however, the duration for which APT should be maintained after SACE remains largely unexplored. 13 Although determining the optimal duration of APT necessitates finding a balance between thromboembolic…”

Strategies to Prevent Ischemic Complications after Stent-assisted Coil Embolization of Cerebral Aneurysms

“…Until the stent surface is covered by the neointima, metal exposure activates platelets, leading to thrombus formation; therefore, to prevent delayed ischemic complications, it is necessary to continue DAPT for a specific period. 2 , 21 , 22) Regarding this period, no guidelines or consensus has been established, but a previous study reported that continuous DAPT for 9 months significantly reduced the incidence of ischemic complications without increasing the incidence of hemorrhagic complications. 4) We aim for the termination of antiplatelet therapy approximately 1 year after surgery.…”

Investigation of Safe Termination of Antiplatelet Therapy after LVIS Stent-assisted Cerebral Aneurysm Coiling

“…However, it has been reported that AT termination at least 6 months postoperatively did not result in ischemic events among patients with neointima formation after ES-assisted cerebral aneurysm coiling. 5) This suggests that, if neointima formation occurs after stent placement, AT can be terminated without ischemic events. Recently, the LVIS stent (LS; Low-profile Visualized Intraluminal Support device: MicroVention TERUMO, Tustin, CA, USA) has been available for cerebral aneurysm treatment in Japan as a new design braided stent that enables excellent wall apposition due to manipulation even if the parent artery is tortuous, like the carotid siphon (Fig.…”