المؤلفون: Jun Seok Koh, Gyojun Hwang, Jung Cheol Park, Chang-Young Lee, Joonho Chung, Sang-Weon Lee, Hyon-Jo Kwon, Seong-Rim Kim, Dong-Hun Kang, Soon Chan Kwon, Sung-Tae Kim, Chul Hoon Chang, Dong-Kyu Jang, Jae Hyung Choi, Young Woo Kim, Bum-Tae Kim, Byoung Gook Shin, Seung Hoon You, Seung Young Chung, Junkyeung Ko

المصدر: Journal of NeuroInterventional Surgery; Nov2023, Vol. 15 Issue 11, p1095-1104, 10p

مصطلحات موضوعية: MEDICINE, CLINICAL trials, SURGICAL stents, PLASTIC surgery, TREATMENT effectiveness, CLOPIDOGREL, PLATELET aggregation inhibitors, RESEARCH funding, DESCRIPTIVE statistics, ASPIRIN, THROMBOEMBOLISM, LOGISTIC regression analysis, INTRACRANIAL aneurysms, PATIENT safety

مصطلحات جغرافية: SOUTH Korea

مستخلص: Background Antiplatelet therapy, where regimens are tailored based on platelet function testing, has been introduced into neurointerventional surgery. This nationwide registry study evaluated the effect and safety of tailored antiplatelet therapy in stent assisted coiling for unruptured aneurysms compared with conventional therapy using a standard regimen. Methods This study enrolled 1686 patients in 44 participating centers who received stent assisted coiling for unruptured aneurysms between January 1, 2019 and December 31, 2019. The standard regimen (aspirin and clopidogrel) was used for all patients in the conventional group (924, 19 centers). The regimen was selected based on platelet function testing (standard regimen for clopidogrel responders; adding cilostazol or replacing clopidogrel with other thienopyridines (ticlopidine, prasugrel, or ticagrelor) for clopidogrel non-responders) in the tailored group (762, 25 centers). The primary outcome was thromboembolic events. Secondary outcomes were bleeding and poor outcomes (increase in modified Rankin Scale score). Outcomes within 30 days after coiling were compared using logistic regression analysis. Results The thromboembolic event rate was lower in the tailored group than in the conventional group (30/762 (3.9%) vs 63/924 (6.8%), adjusted OR 0.560, 95% CI 0.359 to 0.875, P=0.001). The bleeding event rate was not different between the study groups (62/762 (8.1%) vs 73/924 (7.9%), adjusted OR 0.790, 95% CI 0.469 to 1.331, P=0.376). Poor outcomes were less frequent in the tailored group (12/762 (1.6%) vs 34 (3.7%), adjusted OR 0.252, 95% CI 0.112 to 0.568, P=0.001). Conclusion Tailored antiplatelet therapy in stent assisted coiling for unruptured aneurysms reduced thromboembolic events and poor outcomes without increasing bleeding. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of NeuroInterventional Surgery is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: JeongWook Lim, Young Dae Cho, Noah Hong, Jeongjun Lee, Dong Hyun Yoo, Hyun- Seung Kang

المصدر: Journal of NeuroInterventional Surgery; May2021, Vol. 13 Issue 5, p434-437, 5p

مصطلحات موضوعية: INTRACRANIAL aneurysm surgery, MAGNETIC resonance angiography, SURGICAL stents, CASE-control method, DISEASE incidence, TREATMENT effectiveness, HYPERLIPIDEMIA, DESCRIPTIVE statistics, ODDS ratio, PROPORTIONAL hazards models

مصطلحات جغرافية: SOUTH Korea

مستخلص: Background The impact of various stents on patients with intracranial aneurysms who undergo stent- assisted coiling has been debated. We conducted this study to compare follow- up outcomes of coiling procedures involving braided or laser- cut stents with closed- cell design. A propensity score- matched case- controlled analysis was applied. Methods A total of 413 intracranial aneurysms consecutively coiled using laser- cut (n=245) or braided stents (n=168) in procedures performed between September 2012 and June 2017 were eligible for study. Time- of- flight magnetic resonance angiography, catheter angiography, or both were used to gauge occlusive status after coiling. Recanalization was determined by Raymond classification (complete occlusion vs recanalization). A propensity score- matched analysis was conducted, based on probability of stent type in use. Results Ultimately, 93 coiled aneurysms (22.5%) showed some recanalization (minor, 51; major, 42) during the follow- up period (mean 21.7±14.5 months). Patient gender (P=0.042), hyperlipidemia (P=0.015), size of aneurysm (P=0.004), neck size (P<0.001), type of aneurysm (P<0.001), and packing density (P=0.024) differed significantly by group. Midterm and cumulative recanalization incidence rates in the braided- stent group were initially lower than those of the laser- cut stent group (P=0.009 and P=0.037, respectively) but they did not differ significantly after 1:1 propensity score matching (midterm OR=0.88, P=0.724; cumulative HR=0.91, P=0.758). Conclusion In stent- assisted coiling of intracranial aneurysms, laser- cut and braided stent groups produced similar outcomes in follow- up. Consequently, product selection may hinge on suitability for deployment rather than anticipated results. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of NeuroInterventional Surgery is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

المؤلفون: Young Deok Kim, Jae Seung Bang, Si Un Lee, Won Joo Jeong, O. -Ki Kwon, Seung Pil Ban, Tac Keun Kim, Seung Bin Kim, chang Wan Oh

المصدر: Journal of NeuroInterventional Surgery; Dec2018, Vol. 10 Issue 12, p1-6, 6p, 1 Chart, 3 Graphs

مصطلحات موضوعية: INTRACRANIAL aneurysm surgery, ENDOVASCULAR surgery, CONFIDENCE intervals, INTRACRANIAL aneurysms, LONGITUDINAL method, TREATMENT effectiveness, PROPORTIONAL hazards models, RETROSPECTIVE studies, LOG-rank test

مصطلحات جغرافية: SOUTH Korea

مستخلص: Background The long-term outcomes of endovascular coiling and surgical clipping for the treatment of unruptured intracranial aneurysms are unclear. Methods We performed a nationwide retrospective cohort study using claims data from the Korean health insurance review and assessment service on patients undergoing surgical clipping or endovascular coiling from 2008 to 2014. inverse probability treatment weighting for average treatment effect on the treated and the multiple imputation method were used to balance covariates and handle missing values. The primary outcome was all-cause mortality at 7 years. Results We identified 26 411 patients of whom 11 777 underwent surgical clipping and 14 634 underwent endovascular coiling. after adjustment with the use of inverse probability treatment weighting for average treatment effect on the treated, all-cause mortality rates at 7 years were 3.8% in the endovascular coiling group and 3.6% in the surgical clipping group (hr 1.05; 95% ci 0.86 to 1.28; P=0.60, log-rank test). The adjusted probabilities of aneurysm rupture at 7 years were 0.9% after endovascular coiling and 0.7% after surgical clipping (hr 0.9; 95% ci 0.61 to 1.34; P=0.63, log-rank test). The probabilities of retreatment at 7 years after adjustment were 4.9% in the endovascular coiling group and 3.2% in the surgical clipping group (hr 1.52; 95% ci 1.28 to 1.81; P<0.001, log-rank test). Conclusions all-cause mortality at 7 years was similar between the elective surgical clipping and endovascular coiling groups in patients with unruptured aneurysms who had no history of subarachnoid hemorrhage due to aneurysm rupture. [ABSTRACT FROM AUTHOR]

: Copyright of Journal of NeuroInterventional Surgery is the property of BMJ Publishing Group and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)