Optimal duration of dual antiplatelet therapy for stent-assisted coiling or flow diverter placement.

Background: Dual antiplatelet therapy (DAPT) is necessary to prevent thromboembolic complications after stent-assisted coiling (SAC) or flow-diversion (FD) for cerebral aneurysms, but the optimal antiplatelet regimen remains unclear.
Objective: To determine the optimal DAPT duration in patients with SAC/FD.
Methods: This multicenter cohort study enrolled patients who received SAC/FD for cerebral aneurysms at seven Japanese institutions between January 2010 and December 2020. The primary outcome was the time from procedure to the occurrence of a composite of target vessel-related thromboembolic events, procedure-unrelated major bleeding events, or death. The cumulative event-free survival rates were analyzed using a Kaplan-Meier curve, and the differences in each outcome between the groups dichotomized by the duration of DAPT were analyzed using the log-rank test.
Results: Of 632 patients (median observational period, 646 days), primary outcome occurred in 63 patients (10.0%), most frequently within 30 days after the procedure. The cumulative event-free survival rates at 30 days, 1 year, and 2 years after the procedure were 93.3% (91.4 to 95.3%), 91.5% (89.3 to 93.7%), and 89.5% (87.0 to 92.0%), respectively. The cumulative event-free survival rates after switching to monotherapy were similar for the >91 and <90 days DAPT groups in the population limited to patients who were switched from DAPT to monotherapy without major clinical events.
Conclusions: Thromboembolic events rarely occurred beyond 30 days after SAC/FD. The duration of DAPT may be shortened if patients have a periprocedural period without events. Further prospective studies are warranted to determine the optimal duration of antiplatelet therapy.
Trial Registration Number: UMIN000044122 :https://center6.umin.ac.jp/cgi-open-bin/ctr&#95;e/ctr&#95;view.cgi?recptno=R000050384.
Competing Interests: Competing interests: YEn received a research grant from Sysmex; a lecture fee from Stryker, Medtronic, Johnson and Johnson, Daiichi-Sankyo and Otsuka Pharmaceutical. AI received a lecture fee feom Medtronic, Stryker, Terumo, Johnson and Johnson, Medico's Hirata, Kaneka, Daiichi-Sankyo and Otsuka Pharmaceutical; a research glant from Fuji film. MS received a lecture fee from Medtronic. KSu received a lecture fee from Stryker and Daiichi-Sankyo. IN received a lecture fee from Terumo, Kaneka and Daiichi-Sankyo. TH received a lecture fee from Stryker, Medtronic, Johnson and Johnson, Daiichi-Sankyo and Abbott; a research grant from Stryker, Medtronic, Asahi Intec, Kaneka, Medico's Hirata, Boehringer Ingelheim and Eisai. SY recieved a research grant from Asahi Intec, Biomedical Solution, Medico's Hirata, Medtronic, Otsuka Pharmaceutical, Stryker and Terumo; a lecture fee from Stryker, Medtronic, Johnson and Johnson, Kaneka, Daiichi-Sankyo, Bayer and Bristol-Meyers Squibb.
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