Optimal duration of dual antiplatelet therapy after endovascular treatment of intracranial aneurysms with stenting: a systematic review and meta-analysis.
Publication/Presentation Date
7-31-2025
Abstract
BACKGROUND: The optimal duration of dual antiplatelet therapy (DAPT) following endovascular treatment of intracranial aneurysms remains uncertain. While DAPT effectively prevents thromboembolic complications, prolonged therapy may increase bleeding risk. This systematic review and meta-analysis compared the efficacy and safety of short-term versus long-term DAPT in patients undergoing endovascular treatment with stent-assisted coiling or flow diversion.
METHODS: We conducted a systematic review and meta-analysis according to PRISMA guidelines. Studies were identified through PubMed, Embase and Cochrane from inception to January 2025. Eligible studies included randomized controlled trials (RCTs) and observational cohorts comparing short-term DAPT (≤ 6 months) with long-term DAPT (> 6 months) in adults treated for intracranial aneurysms. Pooled risk ratio (RR) with 95% confidence intervals (CI) were calculated using a random-effects model. Risk of bias was assessed using RoB 2 for RCTs and ROBINS-I for observational studies.
RESULTS: Seven studies, comprising a total of 17,380 patients, were included, one RCT and six retrospective cohorts. The pooled analysis showed no significant difference in thromboembolic events between short- and long-term DAPT (RR: 1.18; 95% CI: 0.42-3.30; I
CONCLUSIONS: Short-term DAPT demonstrates similar efficacy to long-term DAPT in preventing thromboembolic events and retreatment, with a lower incidence of major bleeding. These findings suggest that shorter DAPT regimens may offer a favorable safety profile. However, further large-scale RCTs are needed to establish definitive guidelines.
ISSN
1432-1920
Published In/Presented At
Pereira da Silva, A. M., de Deus, O., Falcão, L., Han, M. L., Ribeiro, F. V., Machado Magalhães, P. L., Melo Neto, A., Meira, O. T., Bastos Maximiano, M. L., Noleto, G. S., Günkan, A., & Jabbour, P. M. (2025). Optimal duration of dual antiplatelet therapy after endovascular treatment of intracranial aneurysms with stenting: a systematic review and meta-analysis. Neuroradiology, 10.1007/s00234-025-03710-1. Advance online publication. https://doi.org/10.1007/s00234-025-03710-1
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
40742483
Department(s)
Administration and Leadership
Document Type
Article