gms | German Medical Science

Objective: Aneurysm recanalization after endovascular treatment (EVT) of intracranial aneurysms remains an unsolved issue. Little is known about the risk-factors contributing to it. Here we assessed if the use of antiplatelet drugs (AP) is associated with aneurysm recanalization following EVT.

Methods: All patients with an intracranial aneurysm treated at our center were entered in a prospectively conducted database. Patients with at least one angiographic follow-up examination 6 months after EVT were selected retrospectively and their charts reviewed. The role of antiplatelet medication as well as of other risk-factors for recanalization requiring retreatment were determined by χ², t-tests and logistic regression analysis.

Results: 293 patients with 315 aneurysms (206 ruptured and 109 unruptured) met the inclusion criteria. Mean follow-up time was 26.83 months (6 to 158 months). 129 (41%) were treated with AP (n=70 with acetylsalicylic acid (ASS), n=10 with clopidogrel (CLOP), and n=48 received both). At least some coil-compaction was noted in 107 (34.0%) aneurysms regardless of the initial angiographic result. 61 aneurysms were retreated at least once.

Patients treated with ASS interestingly were less often retreated than other patients (χ², OR 0.22, CI 0.08-0.64, P=0.003) whereas AP in general were no significant risk-factor. Furthermore, in a multivariate model, also aneurysm size ≥10 mm and an initially incomplete occlusion were significant predictors of a retreatment (P<0.05).

Conclusions: We could not find an increased rate of retreatment due to the administration of AP. Interestingly, ASS even seemed to have a beneficial effect on the retreatment rate in our cohort. Whether this is due to the fact that the more complex aneurysms are more often treated using assisting devices (stents or remodeling techique) thus requiring more aggressive therapy (ASS+CLOP) whereas less complex aneurysms were treated with aspirin only, perhaps to achieve more aggressive occlusion rates, we can not say. One problem remains the indication for AP which is by no means standardized. Last, we can't rule out the existence of a confounding factor we could not indentify.

To further clarify the role of antiplatelet medication after EVT, a prospectively conducted study is needed.