J Cerebrovasc Endovasc Neurosurg.  2019 Sep;21(3):131-137. 10.7461/jcen.2019.21.3.131.

Efficacy of dual antiplatelet therapy as premedication before diagnostic cerebral digital subtraction angiography

• Choo YH
• Jung YJ
• Chang CH
• Kim JH

• KMID: 2465242
• DOI: http://doi.org/10.7461/jcen.2019.21.3.131

Abstract

OBJECTIVE
Several studies have reported that periprocedural dual antiplatelet therapy lowers the incidence of thromboembolic complications (TEC) associated with coiling of unruptured aneurysms. We hypothesized that preprocedural administration of dual antiplatelet agents (aspirin and cilostazol) for 7days may reduce the risk of complications associated with diagnostic cerebral digital subtraction angiography (DSA).
METHODS
We retrospectively reviewed the records of patients who underwent diagnostic cerebral DSA between September 2015 and April 2018. Of the 419 patients included (149 men, 270 women, mean age 58.5 years), 221 (72 men, 149 women, mean age 57.8 years) who underwent cerebral DSA between September 2015 and June 2016 were not premedicated with antiplatelet therapy. The remaining 198 (77 men, 121 women, mean age 59.4 years) who underwent cerebral DSA between July 2016 and April 2018 were premedicated with dual antiplatelet therapy (aspirin and cilostazol). We defined ischemic stroke as a cerebral DSA-induced complication identified on magnetic resonance imaging (MRI) among patients with neurological symptoms.
RESULTS
Of the 221 patients who did not receive antiplatelet therapy, 210 (95.0%) showed no neurological symptoms; however, 11 (5.0%) developed neurological symptoms with MRI-proven ischemic stroke, which represents a TEC. Of the 198 patients who received dual antiplatelet therapy, 196 patients (99.0%) showed no evidence of TEC. The remaining 2 (1.0%) developed diplopia and motor weakness each, and MRI confirmed acute ischemic stroke (p=0.019).
CONCLUSIONS
The use of dual antiplatelet agents (aspirin and cilostazol) for 7 days before DSA may reduce the risk of cerebral DSA-induced TEC.

Keyword

digital subtraction angiography; antiplatelet therapy; premedication; thromboembolism

MeSH Terms

Aneurysm
Angiography, Digital Subtraction*
Diplopia
Female
Humans
Incidence
Magnetic Resonance Imaging
Male
Platelet Aggregation Inhibitors
Premedication*
Retrospective Studies
Stroke
Thromboembolism
Platelet Aggregation Inhibitors

Figure

• 

  Fig. 1 Magnetic resonance image in untreated premedicationDiffusion-weighted magnetic resonance imaging scan obtained in a woman who developed right-sided motor weakness immediately after diagnostic cerebral digital subtraction angiography for an unruptured aneurysm. An acute ischemic stroke involving the left thalamus and both occipital lobes was confirmed as a thromboembolic complication. Of note, she had not been administered premedication.

• 

  Fig. 2 Magnetic resonance image in treated premedicationImage shows a man who was premedicated with dual antiplatelet therapy and was diagnosed with an acute ischemic stroke involving the right pretectal region. He complained of a diplopia.

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