title: Onset Time of Ischemic Events and Antiplatelet Therapy after Intracranial Stent-assisted Coil Embolization.
abstract: BACKGROUND
  Stent-assisted coil embolization is effective for intracranial aneurysms, especially wide-necked aneurysms; however, the optimal antiplatelet regimens for ischemic events that develop after coil embolization have not yet been established. We aimed to determine the onset time of such postoperative ischemic events and the relationship between these events and antiplatelet therapy.
  
  
  METHODS
  We performed coil embolization using a vascular reconstruction stent for 43 cases of intracranial aneurysms and evaluated the incidence of postoperative ischemic events in these cases.
  
  
  RESULTS
  Nine patients showed postoperative ischemic events during the follow-up period (13 ± 7 months). Two patients developed cerebral infarction within 24 hours. Five patients developed transient ischemic attack within 40 days while they were receiving dual antiplatelet therapy. In addition, 1 patient showed cerebral infarction 143 days postoperatively during single antiplatelet therapy, and a case of transient visual disturbance was reported 191 days postoperatively (49 days after antiplatelet therapy had been discontinued). We increased the number of antiplatelet agents in 4 of these patients. The other 5 patients were under strict observation with dual antiplatelet therapy. All these patients were shifted to single antiplatelet therapy 3-13 months postoperatively. No recurrence of ischemic events was noted.
  
  
  CONCLUSIONS
  Postoperative ischemic events are most likely to occur within 40 days postoperatively. For patients with postoperative ischemic events, additional ischemic events can be prevented by increasing the number of antiplatelet agents; subsequently, they can be shifted to single antiplatelet therapy after the risk of recurrence has decreased.
authors: Department of Neurosurgery, Tanushimaru Central Hospital, Fukuoka, Japan.
authors: Yoshihisa
authors: Y
authors: Matsumoto
authors: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan. Electronic address: nakai@sb3.so-net.ne.jp.
authors: Kanji
authors: K
authors: Nakai
authors: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors: Masanori
authors: M
authors: Tsutsumi
authors: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors: Minoru
authors: M
authors: Iko
authors: Department of Neurosurgery, Fukuoka Kieikai Hospital, Fukuoka, Japan.
authors: Kouhei
authors: K
authors: Nii
authors: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors: Sumito
authors: S
authors: Narita
authors: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors: Ayumu
authors: A
authors: Eto
authors: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors: Takahumi
authors: T
authors: Mitsutake
authors: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors: Hiroshi
authors: H
authors: Aikawa
authors: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan.
authors: Kiyoshi
authors: K
authors: Kazekawa
mesh_terms: D000328:Adult; D000368:Aged; D002545:Brain Ischemia / Q000209:etiology*; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D002532:Intracranial Aneurysm / Q000150:complications / Q000628:therapy; D002546:Ischemic Attack, Transient / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects*; D020521:Stroke / Q000209:etiology
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Intracranial aneurysm; antiplatelet therapy; ischemic event; stent-assisted coil embolization