Effects of post-interventional antiplatelet therapy on angiographic vasospasm, delayed cerebral ischemia, and clinical outcome after aneurysmal subarachnoid hemorrhage: a single-center experience
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| Titel: | Effects of post-interventional antiplatelet therapy on angiographic vasospasm, delayed cerebral ischemia, and clinical outcome after aneurysmal subarachnoid hemorrhage: a single-center experience |
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| Autoren: | Claudia Ditz, Björn Machner, Hannes Schacht, Alexander Neumann, Peter Schramm, Volker M. Tronnier, Jan Küchler |
| Quelle: | Neurosurg Rev |
| Verlagsinformationen: | Springer Science and Business Media LLC, 2021. |
| Publikationsjahr: | 2021 |
| Schlagwörter: | 2. Zero hunger, Endovascular Procedures, Subarachnoid Hemorrhage, Brain Ischemia, 3. Good health, Blood Vessel Prosthesis Implantation, 03 medical and health sciences, 0302 clinical medicine, Humans, Vasospasm, Intracranial, Original Article, Aortic Aneurysm, Abdominal [MeSH], Vasospasm, Intracranial/drug therapy [MeSH], Humans [MeSH], Retrospective Studies [MeSH], Subarachnoid Hemorrhage/complications [MeSH], Delayed cerebral ischemia, Platelet Aggregation Inhibitors/therapeutic use [MeSH], Subarachnoid Hemorrhage/surgery [MeSH], Cerebral vasospasm, Brain Ischemia/drug therapy [MeSH], Subarachnoid Hemorrhage/drug therapy [MeSH], Antiplatelet therapy, Vasospasm, Intracranial/etiology [MeSH], Aneurysmal subarachnoid hemorrhage, Endovascular treatment, Blood Vessel Prosthesis Implantation [MeSH], Endovascular Procedures [MeSH], Platelet Aggregation Inhibitors, Aortic Aneurysm, Abdominal, Retrospective Studies |
| Beschreibung: | Platelet activation has been postulated to be involved in the pathogenesis of delayed cerebral ischemia (DCI) and cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to investigate potentially beneficial effects of antiplatelet therapy (APT) on angiographic CVS, DCI-related infarction and functional outcome in endovascularly treated aSAH patients. Retrospective single-center analysis of aSAH patients treated by endovascular aneurysm obliteration. Based on the post-interventional medical regime, patients were assigned to either an APT group or a control group not receiving APT. A subgroup analysis separately investigated those APT patients with aspirin monotherapy (MAPT) and those receiving dual treatment (aspirin plus clopidogrel, DAPT). Clinical and radiological characteristics were compared between groups. Possible predictors for angiographic CVS, DCI-related infarction, and an unfavorable functional outcome (modified Rankin scale ≥ 3) were analyzed. Of 160 patients, 85 (53%) had received APT (n = 29 MAPT, n = 56 DAPT). APT was independently associated with a lower incidence of an unfavorable functional outcome (OR 0.40 [0.19–0.87], P = 0.021) after 3 months. APT did not reduce the incidence of angiographic CVS or DCI-related infarction. The pattern of angiographic CVS or DCI-related infarction as well as the rate of intracranial hemorrhage did not differ between groups. However, the lesion volume of DCI-related infarctions was significantly reduced in the DAPT subgroup (P = 0.011). Post-interventional APT in endovascularly treated aSAH patients is associated with better functional outcome at 3 months. The beneficial effect of APT might be mediated by reduction of the size of DCI-related infarctions. |
| Publikationsart: | Article Other literature type |
| Sprache: | English |
| ISSN: | 1437-2320 0344-5607 |
| DOI: | 10.1007/s10143-021-01477-6 |
| Zugangs-URL: | https://link.springer.com/content/pdf/10.1007/s10143-021-01477-6.pdf https://pubmed.ncbi.nlm.nih.gov/33492514 https://www.ncbi.nlm.nih.gov/pubmed/33492514 https://www.scilit.net/article/cc0fef06304fb57400c1a1901d237072?action=show-references https://link.springer.com/article/10.1007/s10143-021-01477-6 https://link.springer.com/content/pdf/10.1007/s10143-021-01477-6.pdf https://pubmed.ncbi.nlm.nih.gov/33492514/ https://repository.publisso.de/resource/frl:6448909 |
| Rights: | CC BY |
| Dokumentencode: | edsair.doi.dedup.....7e08d1a752a582b7c4402d4354b422b5 |
| Datenbank: | OpenAIRE |
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Nájsť tento článok vo Web of Science | Abstract: | Platelet activation has been postulated to be involved in the pathogenesis of delayed cerebral ischemia (DCI) and cerebral vasospasm (CVS) after aneurysmal subarachnoid hemorrhage (aSAH). The aim of this study was to investigate potentially beneficial effects of antiplatelet therapy (APT) on angiographic CVS, DCI-related infarction and functional outcome in endovascularly treated aSAH patients. Retrospective single-center analysis of aSAH patients treated by endovascular aneurysm obliteration. Based on the post-interventional medical regime, patients were assigned to either an APT group or a control group not receiving APT. A subgroup analysis separately investigated those APT patients with aspirin monotherapy (MAPT) and those receiving dual treatment (aspirin plus clopidogrel, DAPT). Clinical and radiological characteristics were compared between groups. Possible predictors for angiographic CVS, DCI-related infarction, and an unfavorable functional outcome (modified Rankin scale ≥ 3) were analyzed. Of 160 patients, 85 (53%) had received APT (n = 29 MAPT, n = 56 DAPT). APT was independently associated with a lower incidence of an unfavorable functional outcome (OR 0.40 [0.19–0.87], P = 0.021) after 3 months. APT did not reduce the incidence of angiographic CVS or DCI-related infarction. The pattern of angiographic CVS or DCI-related infarction as well as the rate of intracranial hemorrhage did not differ between groups. However, the lesion volume of DCI-related infarctions was significantly reduced in the DAPT subgroup (P = 0.011). Post-interventional APT in endovascularly treated aSAH patients is associated with better functional outcome at 3 months. The beneficial effect of APT might be mediated by reduction of the size of DCI-related infarctions. |
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| ISSN: | 14372320 03445607 |
| DOI: | 10.1007/s10143-021-01477-6 |