Delayed ischemic stroke after PED Placement for Aneurysms: Optimal Duration of Dual Antiplatelet Therapy and Risk Factors

Chao Wang ^1,2 Yangyang Zhou ^1,2 Ying Zhang ^1,2 Dachao Wei ^1,2 Jian Liu ^1,2 Yisen Zhang ^1,2 Kun Wang ^1,2 Hongqi ZHANG ³ Tianxiao Li ⁴ Maimaitili Aisha ⁵ Guohua Mao ⁶ Donglei Song ⁷ Yunyan Wang ⁸ Wenfeng Feng ⁹ Yang Wang ¹⁰ Huaizhang Shi ¹¹ Jieqing Wan ¹² Sheng Guan ¹³ Jianmin Liu ¹⁴ Yuanli Zhao ¹⁴ Wenqiang Li ^1,2* Xinjian Yang ^1,2*

• ¹ Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Dongcheng, Beijing, China
• ² Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
• ³ Department of Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, Beijing Municipality, China
• ⁴ Department of Neurosurgery, People's Hospital of Zhengzhou University, Henan, China
• ⁵ Department of Neurosurgery, First Affiliated Hospital of Xinjiang Medical University, Urumqi, China
• ⁶ Department of Neurosurgery, Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
• ⁷ Department of Neurosurgery, Shanghai Donglei Brain Hospital, Shanghai, China
• ⁸ Department of Neurosurgery, Qilu Hospital of Shandong University, Jinan, Shandong Province, China
• ⁹ Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
• ¹⁰ Department of Neurosurgery, First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi Province, China
• ¹¹ Department of Neurosurgery, First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
• ¹² Department of Neurosurgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
• ¹³ Department of Interventional Radiology, First Affiliated Hospital of Zhengzhou University, Zhengzhou, Henan Province, China
• ¹⁴ Department of Neurosurgery, International Hospital, Peking University, Beijing, Beijing Municipality, China

Delayed ischemic stroke (DIS) is a rare complication that may occur in patients with cerebral aneurysms treated with the Pipeline Embolization device (PED). This study aims to evaluate the characteristics of DIS following PED placement and to investigate the optimal duration of dual antiplatelet therapy (DAPT) in relation to the incidence of DIS.We conducted a multicenter retrospective cohort study on consecutive cases of intracranial aneurysms treated with PED. Patients were divided into two groups based on the timing of DAPT switching to monotherapy: early (<6 months) and late (≥6 months). To adjust for potential biases between the groups, inverse probability of treatment weighting (IPTW) was applied. Kaplan-Meier survival analysis and multivariate Cox regression were used to calculate cumulative DIS rates, and risk factors for DIS.A total of 1,146 consecutive patients with 1296 aneurysms were included, of whom 12 (0.96%) who received PED developed DIS. The late-switch group had a lower DIS rate compared to the early-switch group (0.5%, [4 of 752 patients] vs. 2.0%, [8 of 394 patients], P= 0.018), even after IPTW. Hypertension (hazard ratio [HR] 3.47, 95% CI:1.045-11.552) and complete occlusion immediately post-procedure (HR 5.48, 95% CI: 3.048-9.868) were significant risk factors for DIS.DIS is a rare complication among patients treated with PED for cerebral aneurysms.Extending the duration of DAPT to at least six months may safer for the patients with hypertension and immediate complete occlusion.