Safety Study Of Surgical Clipping For Intracranial Aneurysms In Patients After Dual Antiplatelet Therapy And Failed Endovascular Treatment

Research objectives: To investigate the effect of perioperative dual antiplatelet drugs on microclamping surgery based on patients with intracranial aneurysms who failed endovascular surgery and were switched to open aneurysm clamping,and who were given dual antiplatelet drugs before endovascular treatment to prevent thromboembolic events.Research methods: Patients undergoing cranial aneurysm clamping at the First Hospital of Jilin University from January 2016 to March 2022 were collected in this study and divided into preoperative dual antiplatelet therapy(DAPT)and non-dual antibodies(NDAPT)groups according to the inclusion criteria.In total,there were 1477 patients,including a total of 62 in the DAPT group.The extracted clinical data included age,sex,history of chronic diseases and medication,location and size of aneurysm,preoperative HuntHess grade,complex surgical procedures during surgery,occurrence of postoperative intracranial hemorrhage(asymptomatic or symptomatic),reoperation for postoperative intracranial hemorrhage,and modified Rankin Scale score at discharge and the last follow-up.Statistical analysis was performed using the SPSS(version 25.0).Results:1)From January 2016 to March 2022,1477 patients with cerebral aneurysms were admitted to our center and underwent splint surgery.Among them,62 patients in DAPT group had an average age of 57.52±10.04 years,69.4% were females(n=43).The nonantithrombotic antibody group included 1415 patients,with a mean age of 55.08±8.87 years old,and 63.9% of them were females(n=904).2)In the DAPT group,postoperative rebleeding accounted for 11.3%(n=7),and m RS Score ≥3 accounted for 11.3%(n=7)at the last follow-up.Due to objective selection bias,after 1:2PSM,the average age of patients in DAPT group was 57.52±1.30 years old,accounting for 68.3% of females(n=41),and the average maximum diameter of aneurysms was: 5.54±1.93,postoperative cerebral hemorrhage accounted for 10%(n=6),m RS Score ≥3 accounted for 10%(n=6)at the last followup,and the mean follow-up time was 33.8±17.1 months.3)In this study,by comparative data analysis,the differences between the two groups in postoperative recurrent cerebral hemorrhage(P=0.51),postoperative m RS score(P=0.69),and final m RS score(P=0.77)were not statistically significant,and DAPT did not cause significant adverse outcomes for cerebral aneurysm clamping and had no significant adverse effect on patient prognosis.Conclusions: Antiplatelet agents are an important tool for endovascular treatment of intracranial aneurysms to prevent thromboembolic events.For patients who are to be treated endovascularly and are found to be unable to undergo interventional procedures after DSA,preoperative dual anti-treatment doesn’t increase the risk of cranial clamping procedures and has no obvious adverse effect on patient prognosis.