• Mira Salih, MirHojjat Khorasanizadeh, Mohamed M Salem, Ammad A Baig, Hoon Kim, Brandon Lucke-Wold, Brian L Hoh, Brian T Jankowitz, Jan-Karl Burkhardt, Adnan H Siddiqui, Philipp Taussky, Ajith J Thomas, Justin M Moore, and Christopher S Ogilvy.
• Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston , Massachusetts , USA.
• Neurosurgery. 2023 Nov 1; 93 (5): 100710181007-1018.

Background And ObjectivesEndovascular treatment of unruptured intracranial aneurysms (UIAs) in patients receiving anticoagulant medications has not been well studied. Whether long-term anticoagulation (AC) use affects aneurysmal obliteration rates and treatment-related complications is unclear.MethodsPatients with endovascular treatment for UIA from 4 academic centers were identified and divided into AC and non-AC groups. Periprocedural complications, radiographic and clinical outcomes, and retreatment rates were compared between the 2 groups before and after propensity score matching.ResultsThe initial cohort consisted of 70 patients in the AC group and 355 in the non-AC group. After one-to-one nearest neighbor propensity matching, 38 pairs of patients were compared for periprocedural complications. The total number of complications were higher in the AC group yet not significant (18.4% vs 5.3%, P = .15). After adding imaging follow-up duration to matched variables, 36 pairs were obtained. There was no significant difference in Raymond-Roy occlusion rate between the 2 groups ( P = .74). However, retreatment rate trended higher in the AC group compared with the non-AC group (22.2% vs 5.6%, P = .09). When clinical follow-up duration was added among matched variables, 26 pairs of cases were obtained for long-term clinical outcomes. There was no significant difference in modified Rankin Scale score between the 2 groups ( P = .61). One-to-many nearest neighbor propensities matched analysis with bigger sample sizes yielded similar results.ConclusionThe use of anticoagulants does not affect occlusion rates or long-term outcomes in endovascular treatment of UIAs. Retreatment rates were higher in the AC group; however, this was not statistically significant.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

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