{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,23]],"date-time":"2026-05-23T09:06:05Z","timestamp":1779527165013,"version":"3.53.1"},"reference-count":48,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>With the evolution of neuroendovascular treatments, there is a great trend to treat acutely ruptured wide-necked aneurysms with stent-assisted coiling (SAC) and flow diverters (FDs), which inevitably requires dual antiplatelet therapy (DAPT). This therapy can increase the rate of hemorrhagic complications following other neurosurgical maneuvers, such as external ventricular drain (EVD) placement or removal. In this study, the authors aimed to evaluate the safety of DAPT in patients with aneurysmal subarachnoid hemorrhage (SAH) treated with SAC or FDs and the therapy\u2019s potential benefit in reducing cerebral ischemia and cerebral vasospasm.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>In this retrospective study, the authors reviewed the records of patients who had been admitted to their hospital with acute aneurysmal SAH and treated with SAC, FDs, and\/or coiling between 2012 and 2022. Patients were classified into two groups: a DAPT group, including patients who had received DAPT for SAC or FDs, and a non-DAPT group, including patients who had not received any antiplatelet regimen and had been treated with coiling. Perioperative hemorrhagic and ischemic complications and clinical outcomes were compared between the two groups.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>From among 938 cases of acute ruptured aneurysms treated during 10 years of study, 192 patients were included in this analysis, with 96 patients in each treatment group, after propensity score matching. All basic clinical and imaging characteristics were equivalent between the two groups except for the neck size of aneurysms (p &lt; 0.001). EVD-related hemorrhage was significantly higher in the DAPT group than in the non-DAPT group (p = 0.035). In most patients, however, the EVD-related hemorrhage was insignificant. Parent artery or stent-induced thrombosis was higher in the DAPT group than in the non-DAPT group (p = 0.003). The rate of cerebral ischemia was slightly lower in the DAPT group than in the non-DAPT group (11.5% vs 15.6%, p = 0.399). In the multivariate analysis, cerebral ischemia, rebleeding before securing the aneurysm, extracranial hemorrhage, and cerebral vasospasm were the predictive factors of a poor clinical outcome (p &lt; 0.001, p &lt; 0.001, p = 0.038, and p = 0.038, respectively).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>The DAPT regimen may be safe in the setting of acute aneurysmal SAH. Although EVD-related hemorrhage is more common in the DAPT group than the non-DAPT group, it is usually insignificant without any neurological deficit.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2023.7.focus23376","type":"journal-article","created":{"date-parts":[[2023,10,1]],"date-time":"2023-10-01T09:28:12Z","timestamp":1696152492000},"page":"E10","source":"Crossref","is-referenced-by-count":18,"title":["Safety of dual antiplatelet therapy in the acute phase of aneurysmal subarachnoid hemorrhage: a propensity score\u2013matched study"],"prefix":"10.3171","volume":"55","author":[{"given":"Farid","family":"Qoorchi Moheb Seraj","sequence":"first","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Hossein","family":"Mirbolouk","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Firouzgar Hospital, Iran University of Medical Sciences, School of Medicine, Tehran, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marjan","family":"Vaezi","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Firouzgar Hospital, Iran University of Medical Sciences, School of Medicine, Tehran, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Feizollah","family":"Ebrahimnia","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Reza","family":"Gorji","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sajjad","family":"Najafi","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"},{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"},{"name":"Department of Neurosurgery, Emam Hospital, Mazandaran University of Medical Sciences, School of Medicine, Sari, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hashem","family":"Pahlavan Shamsi","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Sadeghian Shahi","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Payam","family":"Sasannejad","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samira","family":"Zabihyan","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ashkan","family":"Mowla","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Division of Stroke and Endovascular Neurosurgery, Keck School of Medicine, University of Southern California, Los Angeles, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Kheradmand","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Humain","family":"Baharvahdat","sequence":"additional","affiliation":[{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"},{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"},{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"},{"name":"Neurosurgical Department, Neurovascular Section, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran;"},{"name":"Department of Interventional Neuroradiology, Rothschild Foundation Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Neurosurgery","first-page":"584","article-title":"Comparison of low-profiled visualized intraluminal support stent-assisted coiling and coiling only for acutely ruptured intracranial aneurysms: safety and efficacy based on a propensity score-matched cohort study","volume":"87","author":"Xue G","year":"2020","unstructured":"Xue G, Zuo Q, Tang H,  Comparison of low-profiled visualized intraluminal support stent-assisted coiling and coiling only for acutely ruptured intracranial aneurysms: safety and efficacy based on a propensity score-matched cohort study. Neurosurgery. 2020;87(3):584\u2013591."},{"issue":"5","key":"b2","series-title":"Interv Neuroradiol","first-page":"638","article-title":"Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase","volume":"27","author":"Y\u0131ld\u0131r\u0131m IO","year":"2021","unstructured":"Y\u0131ld\u0131r\u0131m IO, Kolu M, Durak MA,  Y-stent assisted coiling of ruptured wide neck intracranial aneurysm in the acute phase. Interv Neuroradiol. 2021;27(5):638\u2013647."},{"issue":"5","key":"b3","series-title":"J Neurointerv Surg","first-page":"489","article-title":"Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review","volume":"11","author":"Zhang X","year":"2019","unstructured":"Zhang X, Zuo Q, Tang H,  Stent assisted coiling versus non-stent assisted coiling for the management of ruptured intracranial aneurysms: a meta-analysis and systematic review. J Neurointerv Surg. 2019;11(5):489\u2013496."},{"issue":"3","key":"b4","series-title":"J Neurosurg","first-page":"724","article-title":"Antiplatelet therapy discontinuation after stent-assisted coil embolization for intracranial aneurysms: a single-center, long-term, retrospective, observational study","volume":"138","author":"Goto S","year":"2022","unstructured":"Goto S, Izumi T, Nishihori M,  Antiplatelet therapy discontinuation after stent-assisted coil embolization for intracranial aneurysms: a single-center, long-term, retrospective, observational study. 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Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms. Neurosurg Rev. 2022;45(4):2787\u20132795."},{"issue":"2","key":"b7","series-title":"Neurosurg Rev","first-page":"397","article-title":"Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis","volume":"43","author":"Cagnazzo F","year":"2020","unstructured":"Cagnazzo F, Di Carlo DT, Petrella G, Perrini P. Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis. 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Increased risk of ventriculostomy-associated hemorrhage in patients treated with antiplatelet agents for stent-assisted coiling of ruptured intracranial aneurysms. Br J Neurosurg. 2021;35(3):270\u2013274."},{"issue":"6","key":"b13","series-title":"World Neurosurg","first-page":"1653","article-title":"Ventriculostomy-related hemorrhage after treatment of acutely ruptured aneurysms: the influence of anticoagulation and antiplatelet treatment","volume":"84","author":"Bruder M","year":"2015","unstructured":"Bruder M, Schuss P, Konczalla J,  Ventriculostomy-related hemorrhage after treatment of acutely ruptured aneurysms: the influence of anticoagulation and antiplatelet treatment. 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J Neurosurg. 2018;129(3):702\u2013710."},{"issue":"6","key":"b15","series-title":"Neurosurgery","first-page":"827","article-title":"Post-treatment antiplatelet therapy reduces risk for delayed cerebral ischemia due to aneurysmal subarachnoid hemorrhage","volume":"85","author":"Darkwah Oppong M","year":"2019","unstructured":"Darkwah Oppong M, Gembruch O, Pierscianek D,  Post-treatment antiplatelet therapy reduces risk for delayed cerebral ischemia due to aneurysmal subarachnoid hemorrhage. Neurosurgery. 2019;85(6):827\u2013833."},{"issue":"7","key":"b16","series-title":"AJNR Am J Neuroradiol","first-page":"1201","article-title":"Antiplatelet therapy in patients with aneurysmal SAH: impact on delayed cerebral ischemia and clinical outcome. A meta-analysis","volume":"40","author":"Cagnazzo F","year":"2019","unstructured":"Cagnazzo F, Derraz I, Lefevre PH,  Antiplatelet therapy in patients with aneurysmal SAH: impact on delayed cerebral ischemia and clinical outcome. A meta-analysis. 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Ventriculostomy-related intracranial hemorrhage following surgical and endovascular treatment of ruptured aneurysms. Neurosurg Rev. 2022;45(4):2787\u20132795."},{"issue":"2","key":"b7","series-title":"Neurosurg Rev","first-page":"397","article-title":"Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis","volume":"43","author":"Cagnazzo F","year":"2020","unstructured":"Cagnazzo F, Di Carlo DT, Petrella G, Perrini P. Ventriculostomy-related hemorrhage in patients on antiplatelet therapy for endovascular treatment of acutely ruptured intracranial aneurysms. A meta-analysis. 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Increased risk of ventriculostomy-associated hemorrhage in patients treated with antiplatelet agents for stent-assisted coiling of ruptured intracranial aneurysms. Br J Neurosurg. 2021;35(3):270\u2013274."},{"issue":"6","key":"b13","series-title":"World Neurosurg","first-page":"1653","article-title":"Ventriculostomy-related hemorrhage after treatment of acutely ruptured aneurysms: the influence of anticoagulation and antiplatelet treatment","volume":"84","author":"Bruder M","year":"2015","unstructured":"Bruder M, Schuss P, Konczalla J,  Ventriculostomy-related hemorrhage after treatment of acutely ruptured aneurysms: the influence of anticoagulation and antiplatelet treatment. World Neurosurg. 2015;84(6):1653\u20131659."},{"issue":"3","key":"b14","series-title":"J Neurosurg","first-page":"702","article-title":"Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage: association with reduced risk of clinical vasospasm and delayed cerebral ischemia","volume":"129","author":"Nagahama Y","year":"2018","unstructured":"Nagahama Y, Allan L, Nakagawa D,  Dual antiplatelet therapy in aneurysmal subarachnoid hemorrhage: association with reduced risk of clinical vasospasm and delayed cerebral ischemia. 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