Impact of antithrombotic therapy on outcomes of incidental unruptured intracranial aneurysms in patients with ischemic stroke.
In patients with small incidental saccular unruptured intracranial aneurysms and acute ischemic stroke, standard antithrombotic regimens do not appear to increase the risk of aneurysm rupture.
Where it sits
this study against the rest of the mazdutide (ibi362) corpusSummary and findings
This study evaluated the impact of antithrombotic therapy on aneurysm rupture risk in patients with acute ischemic stroke and incidental unruptured intracranial aneurysms. A total of 197 patients were analyzed, with outcomes measured over a mean follow-up of 28.6 months. Aneurysm rupture occurred in two patients (1.0%).
Abstract
<h4>Background</h4>The coexistence of acute ischemic stroke (AIS) and unruptured intracranial aneurysms (UIAs) is relatively common, but the safety of antithrombotic therapy in this population remains uncertain. This study evaluated whether different secondary prevention regimens influence UIA progression or rupture risk.<h4>Methods</h4>This single-center retrospective cohort study included patients with AIS and concomitant saccular UIAs between January 2016 and December 2021. Patients were categorized according to long-term antithrombotic exposure: single antiplatelet therapy (SAPT), anticoagulation, or no regular therapy. Dual antiplatelet therapy (DAPT) was analyzed separately. The primary outcome was aneurysm rupture; secondary outcomes included symptomatic events and radiographic progression (≥1 mm growth).<h4>Results</h4>Among 197 patients (mean age 68.4 ± 10.2 years; 53.8% female), 140 received SAPT, 36 received anticoagulation, and 21 received no regular therapy. During a mean follow-up of 28.6 ± 18.4 months, aneurysm rupture occurred in two patients (1.0%). No ruptures occurred in the anticoagulation group. Firth's penalized logistic regression showed no significant association between antithrombotic regimen and aneurysm rupture (anticoagulation vs SAPT: OR 0.41, 95% CI 0.01-5.21; no therapy vs SAPT: OR 3.21, 95% CI 0.21-45.6; both <i>p</i> > 0.05).<h4>Conclusions</h4>In patients with small incidental saccular UIAs and AIS, standard secondary prevention regimens were not associated with an increased risk of aneurysm rupture. However, the limited number of rupture events and potential residual confounding warrant cautious interpretation. Secondary stroke prevention should remain the priority, with individualized assessment of aneurysm-related risks.
Background
The coexistence of acute ischemic stroke and unruptured intracranial aneurysms is common, yet the safety of antithrombotic therapy in this context is unclear. Previous studies have not definitively established the influence of different secondary prevention regimens on the progression or rupture risk of incidental unruptured intracranial aneurysms. This study aims to fill that gap by evaluating the effects of antithrombotic therapy on these outcomes.
Methods
This was a single-center retrospective cohort study that included patients with acute ischemic stroke and concomitant saccular unruptured intracranial aneurysms from January 2016 to December 2021. Patients were categorized based on their long-term antithrombotic exposure: single antiplatelet therapy, anticoagulation, or no regular therapy, with dual antiplatelet therapy analyzed separately. The primary outcome was aneurysm rupture, while secondary outcomes included symptomatic events and radiographic progression of ≥1 mm growth.
Results
Among 197 patients (mean age 68.4 ± 10.2 years; 53.8% female), aneurysm rupture occurred in two patients (1.0%) during a mean follow-up of 28.6 ± 18.4 months. No ruptures occurred in the anticoagulation group. Firth's penalized logistic regression indicated no significant association between antithrombotic regimen and aneurysm rupture, with p-values greater than 0.05.
Interpretation
The findings suggest that standard secondary prevention regimens may not significantly increase the risk of aneurysm rupture in patients with small incidental saccular UIAs and acute ischemic stroke. However, the effect sizes are small, and the limited number of rupture events raises concerns about the robustness of these conclusions. The study's retrospective design and potential confounding factors limit the ability to draw definitive conclusions, emphasizing the need for individualized assessment of aneurysm-related risks in clinical practice.
Key findings
- Aneurysm rupture occurred in two patients (1.0%) during a mean follow-up of 28.6 ± 18.4 months, n=197.
- No ruptures occurred in the anticoagulation group.
- Firth's penalized logistic regression showed no significant association between antithrombotic regimen and aneurysm rupture (anticoagulation vs SAPT: OR 0.41, 95% CI 0.01-5.21; no therapy vs SAPT: OR 3.21, 95% CI 0.21-45.6; both p > 0.05).
Limitations
- small n=197
- retrospective cohort study
- limited number of rupture events
- potential residual confounding
- single-center study