{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,7]],"date-time":"2026-03-07T20:34:37Z","timestamp":1772915677784,"version":"3.50.1"},"reference-count":14,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2012,11]]},"abstract":"\nObject<\/jats:title>\nThe optimal antiplatelet medication protocol for prevention of thrombotic complications after stent-assisted coil embolization of cerebral aneurysms is unclear. Early cessation of antiplatelet agents may be associated with an increased risk of cerebral ischemic events. In this study, the authors assess the incidence of stroke or transient ischemic attack (TIA) following discontinuation of a 6-week course of clopidogrel in patients with cerebral aneurysms treated with stent-assisted techniques.<\/jats:p><\/jats:sec>\n\nMethods<\/jats:title>\nA retrospective review was conducted in all patients with cerebral aneurysms undergoing stent-assisted coil embolization or stent-in-stent flow diversion at the University of Iowa during a 24-month period. The antiplatelet protocol was 81 mg aspirin and 75 mg clopidogrel daily for 6 weeks, followed by 325 mg aspirin daily indefinitely. The incidence of stroke or TIA was determined by a retrospective review of medical records generated during a 3-month period following discontinuation of clopidogrel.<\/jats:p><\/jats:sec>\n\nResults<\/jats:title>\nA total of 154 patients underwent aneurysm treatment with stent techniques during this interval. Documentation of neurological follow-up 3 months after discontinuation of a 6-week clopidogrel treatment was available in 121 (78.6%) of 154 patients. Of these 121 patients, 114 were treated with stent-assisted coil embolization and 7 with stent-in-stent flow diversion. Six patients (5%) suffered an ischemic event after cessation of clopidogrel, with 2 events occurring within the first 2 weeks. Specifically, the rate of ischemic events was 5 (4.3%) of 114 in the \u201cstent-coil\u201d treatment group and 1 (14.3%) of 7 in the stent-in-stent group. Treatment had been performed in the setting of a subarachnoid hemorrhage in 1 patient. Atypical aneurysm features and technical factors predisposing to thrombotic events were found in all but one of these patients. Similarly, cardiovascular risk factors were present in 5 of the 6 patients in whom ischemic events developed after clopidogrel discontinuation.<\/jats:p><\/jats:sec>\n\nConclusions<\/jats:title>\nClopidogrel discontinuation is associated with a 5% risk of ischemic events in patients treated with stent techniques. Any stroke related to clopidogrel discontinuation is avoidable, and longer treatment is therefore clearly necessary. Patients with cardiovascular risk factors, high-risk aneurysm features, and those undergoing stent-in-stent flow diversion might benefit the most from longer clopidogrel therapy.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2012.8.jns12185","type":"journal-article","created":{"date-parts":[[2012,9,7]],"date-time":"2012-09-07T13:57:03Z","timestamp":1347026223000},"page":"929-933","source":"Crossref","is-referenced-by-count":57,"title":["Incidence of cerebral ischemic events after discontinuation of clopidogrel in patients with intracranial aneurysms treated with stent-assisted techniques"],"prefix":"10.3171","volume":"117","author":[{"given":"James D.","family":"Rossen","sequence":"first","affiliation":[{"name":"Internal Medicine, Division of Cardiovascular Medicine, University of Iowa, Iowa City, Iowa;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nohra","family":"Chalouhi","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shafik N.","family":"Wassef","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"McConnell Brain Imaging Centre, Montreal Neurological Institute and Hospital; and"},{"name":"Department of Neurology and Neurosurgery, McGill University, Montreal, Quebec, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jacob","family":"Thomas","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Taylor J.","family":"Abel","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pascal M.","family":"Jabbour","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David K.","family":"Kung","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David M.","family":"Hasan","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns12185","series-title":"N Engl J Med","first-page":"710","article-title":"Treatment of acute ischemic stroke","volume":"343","author":"Brott","year":"2000"},{"key":"b2-jns12185","series-title":"AJNR Am J Neuroradiol","first-page":"1389","article-title":"Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: a single-center experience","volume":"29","author":"Lee","year":"2008"},{"key":"b3-jns12185","series-title":"N Engl J Med","first-page":"1665","article-title":"A clinical trial comparing three antithrombotic-drug regimens after coronary-artery stenting","volume":"339","author":"Leon","year":"1998"},{"key":"b4-jns12185","series-title":"Neurosurgery","first-page":"908","article-title":"Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: is it safe? 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Apropos of 56 cases.]","volume":"24","author":"Moret","year":"1997"},{"key":"b6-jns12185","series-title":"Circulation","first-page":"2364","article-title":"Effectiveness of clopidogrel and aspirin versus ticlopidine and aspirin in preventing stent thrombosis after coronary stent implantation","volume":"99","author":"Moussa","year":"1999"},{"key":"b7-jns12185","series-title":"Catheter Cardiovasc Interv","first-page":"1047","article-title":"Antiplatelet therapy discontinuation following drug-eluting stent placement: dangers, reasons, and management recommendations","volume":"74","author":"Moussa","year":"2009"},{"key":"b8-jns12185","series-title":"Stroke","first-page":"110","article-title":"Stent-assisted coiling of intracranial aneurysms: clinical and angiographic results in 216 consecutive aneurysms","volume":"41","author":"Piotin","year":"2010"},{"key":"b9-jns12185","series-title":"Stroke","first-page":"1310","article-title":"Subacute stent thrombosis in intracranial stenting","volume":"40","author":"Riedel","year":"2009"},{"key":"b10-jns12185","series-title":"Thromb Haemost","first-page":"211","article-title":"Clopidogrel withdrawal: is there a \u201crebound\u201d phenomenon?","volume":"105","author":"Sambu","year":"2011"},{"key":"b11-jns12185","series-title":"N Engl J Med","first-page":"1084","article-title":"A randomized comparison of antiplatelet and anticoagulant therapy after the placement of coronaryartery stents","volume":"334","author":"Sch\u00f6mig","year":"1996"},{"key":"b12-jns12185","series-title":"Thromb Haemost","first-page":"910","article-title":"Correlation of a new point-of-care test with conventional optical aggregometry for the assessment of clopidogrel responsiveness","volume":"95","author":"von Beckerath","year":"2006"},{"key":"b13-jns12185","series-title":"N Engl J Med","first-page":"2001","article-title":"Prasugrel versus clopidogrel in patients with acute coronary syndromes","volume":"357","author":"Wiviott","year":"2007"},{"key":"b14-jns12185","series-title":"AJNR Am J Neuroradiol","first-page":"1778","article-title":"Effect of antiplatelet therapy on thromboembolic complications of elective coil embolization of cerebral aneurysms","volume":"28","author":"Yamada","year":"2007"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/117\/5\/article-p929.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/117\/5\/article-p929.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg\/117\/5\/article-p929.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,26]],"date-time":"2023-03-26T23:02:28Z","timestamp":1679871748000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/117\/5\/article-p929.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2012,11]]},"references-count":14,"journal-issue":{"issue":"5"},"URL":"https:\/\/doi.org\/10.3171\/2012.8.jns12185","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2012,11]]}}}