Discontinuation of antiplatelet therapy after stent-assisted coil embolisation of cerebral aneurysm:a nationwide cohort study

Introduction Stent-assisted coil embolisation(SACE)for the treatment of unruptured cerebral aneurysms has been increasingly used.Long-term advantages of antiplatelet therapy(APT)post-SACE treatment are still not well understood.We investigated the long-term effects of APT on clinical prognosis after SACE.Patients and methods We conducted a retrospective study using nationwide health insurance claims data from South Korea,including patients with cerebral aneurysm treated with SACE from January 2009 to December 2020.The study outcomes consisted of the occurrence of cerebral infarction and major haemorrhage.To evaluate the impact of APT,we employed a multivariable time-dependent Cox proportional hazards regression model for each of the three distinct periods:1–12 months,12–24 months and>24 months after SACE.Results This study included 17692 unruptured cerebral aneurysm patients treated with SACE.During the mean follow-up of 4.2 years,there were 379(2.1%)patients with cerebral infarction and 190(1.1%)patients with major haemorrhage.The percentage of patients receiving APT was 79.5%at 1year,which gradually decreased to 58.3%at 2 years after SACE.APT was beneficial in preventing cerebral infarction within 12 months after SACE(adjusted HR(aHR)0.56;95%CI,0.35 to 0.89;p=0.014).After 12 months,this association was not evident.APT increased the risk of haemorrhage after 24 months(aHR 1.76;95%CI 1.11 to 2.87;p=0.016).Discussion and conclusion Our findings suggest that in patients with unruptured cerebral aneurysm treated with SACE,the reasonable duration of APT for preventing cerebral infarction might be 1year after SACE.

Association between statin therapy and the risk of stroke in patients with moyamoya disease:a nationwide cohort study

Background and objective Knowledge regarding the pharmacological treatment for moyamoya disease(MMD),a chronic and progressive cerebrovascular disease conferring greater stroke risk,is limited.In the present study,whether statin therapy is associated with a reduced risk of stroke in patients with MMD was investigated.Methods This was a retrospective cohort study in which the occurrence of stroke in patients with newly diagnosed MMD was investigated using the nationwide health insurance database in Korea from January 2007 to March 2021.A multivariable Cox proportional hazards regression model was constructed for stroke,in which statin therapy after MMD diagnosis was treated as a time-dependent variable.Adjustment was done for sex,age,presence of comorbidities,concurrent stroke,revascularisation surgery and treatment with antiplatelets.Results The present study included 13373 newly diagnosed patients with MMD;40.8%had a concurrent stroke at the time of MMD diagnosis.During the mean follow-up of 5.1±3.3 years,631 patients(4.7%)suffered a stroke event(haemorrhagic stroke:458 patients,ischaemic stroke:173 patients).Statin therapy after MMD diagnosis was significantly associated with a reduced risk of stroke(adjusted HR 0.74;95%CI 0.60 to 0.91,p=0.004).In the secondary outcome analysis,the risk of haemorrhagic stroke(adjusted HR 0.74;95%CI 0.58 to 0.95,p=0.018)and ischaemic stroke(adjusted HR 0.75;95%CI 0.52 to 1.08,p=0.124)were reduced with the statin treatment.Taking statins was also associated with a lower risk of all-cause mortality(adjusted HR 0.47;95%CI 0.33 to 0.67,p<0.001).Conclusion In patients with MMD,statin therapy was associated with a reduced risk of subsequent stroke.The findings indicate statin treatment may be beneficial for patients with MMD,however the results should be confirmed in randomised controlled trials.