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Does dual antiplatelet therapy increase the risk of haematoma enlargement in the acute stage? A retrospective study of the use of stent-assisted coiling versus coiling alone or balloon-assisted coiling for the treatment of ruptured intracranial aneurysms combined with intracranial haematoma

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Abstract

This study aims to identify the efficacy and safety of stent-assisted coiling (SAC) treatment of ruptured intracranial aneurysms (RIAs) combined with intracranial haematoma (ICH) compared to coiling alone or balloon-assisted coiling (non-SAC). A retrospective analysis of 54 consecutive patients receiving endovascular therapy from 2014 to 2020 was performed. The data collected included baseline characteristics, angiographic results, perioperative complications, immediate aneurysm occlusion, clinical outcomes, follow-up at discharge and after 6 months, hospitalisation costs, and inpatient length of stay. Patients were categorised into the SAC group and the non-SAC group. Univariate and multivariate logistic regression analyses were used to identify risk factors related to clinical outcomes. Of the 54 patients harbouring RIAs with ICH, 22 (40.74%) and 32 (59.26%) patients were subject to SAC and non-SAC treatments, respectively. Postoperative rebleeding (1 [4.5%] and 3 [9.3%] in SAC and non-SAC groups, respectively, p > 0.05) and Hunt-Hess grade (IV-V) lesions (13.6% vs. 40.6%, p = 0.067) did not differ between the two groups. In total, 10 (45.5%) patients treated with SAC received a Fisher scale score of 0–3 compared with 6 (18.8%) patients treated with non-SAC methods (p = 0.035). Compared with the non-SAC group (7/21.9%), the rate of wide-necked aneurysms was increased in the SAC group (11/50%) (p = 0.031). No differences in poor outcomes (mRS > 2) were noted between the SAC and non-SAC groups (p > 0.05). Multivariate analysis revealed that ischaemic complication events (p = 0.016) represent the only independent risk factor for adverse outcomes, and a trend towards unfavourable clinical outcomes was noted for patients who smoke (p = 0.087). SAC is a safe and efficient treatment for RIAs combined with ICH when dual antiplatelet therapy (DAPT) is used in the perioperative period. In addition, SAC should be preferentially used in wide-neck RIAs. Ischaemic complications are a risk factor for poor clinical outcomes. Given the small sample size and retrospective bias of this study, these findings should be further verified in a study with a larger sample size or a randomised controlled trial (RCT).

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Funding

This work was supported by the following projects: (1) Project of The Health Commission of Jiangxi Province of China (Number: 20195115), (2) Natural Science Fund of Jiangxi Province of China (Number:20192BAB215024), and (3) Natural Science Fund of Jiangxi Province of China (Number:20202BABL206055).

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Authors and Affiliations

  1. Queen Mary School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China

    Ruoxi Cheng, Peiyi Luo, Weiyun Zhang & Xiao Qian

  2. The First Clinical Medical School, Jiangxi Medical College, Nanchang University, Nanchang, Jiangxi, China

    Kangtai Su

  3. Department of Neurosurgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China

    Xiaobing Zhou & Lingfeng Lai

  4. Department of Neurology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China

    Xin Jiang

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  1. Ruoxi Cheng
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Contributions

Conceptualization: Ruoxi Cheng, Lingfeng Lai; methodology: Ruoxi Cheng; formal analysis and investigation: Ruoxi Cheng, Xiaobing Zhou, Kangtai Su; writing – original draft preparation: Ruoxi Cheng, Xin Jiang; writing – review: Ruoxi Cheng, Peiyi Luo, Weiyun Zhang, Xiao Qian; funding acquisition: Lingfeng Lai; resources: Lingfeng Lai; supervision: Lingfeng Lai.

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Correspondence to Lingfeng Lai.

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The study was approved by the Institutional Review Board of the First Affiliated Hospital of Nanchang University.

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Cheng, R., Su, K., Zhou, X. et al. Does dual antiplatelet therapy increase the risk of haematoma enlargement in the acute stage? A retrospective study of the use of stent-assisted coiling versus coiling alone or balloon-assisted coiling for the treatment of ruptured intracranial aneurysms combined with intracranial haematoma. Neurosurg Rev 46, 133 (2023). https://doi.org/10.1007/s10143-023-02036-x

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