Delayed Ischemic Stroke after Stent-assisted Coil Placement in Cerebral Aneurysm: Characteristics and Optimal Duration of Preventative Dual Antiplatelet Therapy

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Delayed ischemic stroke after stent-assisted coil repair of cerebral aneurysm is caused by embolism from the stent or thrombotic occlusion of the stent-containing vessel after early switch of dual antiplatelet therapy to monotherapy, and thus longer-term dual antiplatelet therapy for more than 9 months and late switch to monotherapy are necessary to prevent delayed ischemic stroke.


To evaluate characteristics of delayed ischemic stroke after stent-assisted coil placement in cerebral aneurysms and to determine the optimal duration of dual antiplatelet therapy for its prevention.

Materials and Methods

This retrospective study was approved by the institutional review board, and the requirement to obtain written informed consent was waived. Of 1579 patients with 1661 aneurysms, 395 patients (25.0%) with 403 aneurysms (24.3%) treated with stent-assisted coil placement were included and assigned to groups stratified as early (126 patients [31.9%]; 3 months of coil placement), midterm (160 patients [40.5%]; 6 months), or late (109 patients [27.6%]; ≥9 months), according to the time points of switching dual antiplatelet therapy to monotherapy from coil placement. Cumulative rates of delayed ischemic stroke in each group were calculated by using Kaplan-Meier estimates that were compared with log-rank tests. Risk factors of delayed ischemic stroke were identified by using Cox proportional hazard analysis.


Delayed ischemic stroke occurred in 3.5% of all cases (embolism, 3.0%; thrombotic occlusion, 0.5%) within 2 months following the switch. Late switch yielded no delayed ischemic stroke, unlike early (seven of 126 patients [5.6%]; P = .013) or midterm (seven of 160 patients [4.4%]; P = .028) switch. Incomplete occlusion (hazard ratio, 6.68 [95% confidence interval: 1.490, 29.900]) was identified as a risk factor.


Delayed ischemic stroke after stent-assisted coil placement is caused by embolism from or thrombotic occlusion of stent-containing vessels after switching from dual antiplatelet therapy to monotherapy. The stent-containing vessel with incomplete aneurysm occlusion presents as a long-term thromboembolic source. Therefore, dual antiplatelet therapy for more than 9 months and late switch to monotherapy are recommended for its prevention.

© RSNA, 2014


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Article History

Received January 11, 2014; revision requested February 19; revision received March 17; accepted April 3; final version accepted April 7.
Published online: June 11 2014
Published in print: Oct 2014