Low Risk of Intracranial and Systemic Hemorrhages in Patients on Dual Antiplatelet Treatment Beyond 1 Month Following Neuroendovascular Angioplasty and/or Stent Placement

Background: Aspirin and clopidogrel treatment beyond 1 month in patients undergoing angioplasty and/or stent placement within the extra- and/or intracranial arteries is not defined. OBJECTIVE: To determine the incidence of intracranial and systemic bleeding events, recurrent ischemic stroke, and death in patients treated with dual antiplatelets for greater than 1 month. Methods: We determined rates of hemorrhage, stroke, or death in consecutive patients with extra- or intracranial lesions, treated with dual antiplatelets after angioplasty and/or stent procedures. Results: Dual antiplatelet treatment was initiated in 110 patients following endovascular treatment with a median treatment time period of 3 months (364 person-months of exposure). There were two bleeding events (1 intracranial and 1 gastrointestinal), 1 ischemic stroke, and no deaths. The rate of intracranial and systemic bleeding events, recurrent ischemic stroke, death due to stroke, or premature discontinuation was 8.3 per 1,000 person-months (95%, CI [2.7-25.6]). There were no bleeding events after the first month of treatment. Conclusion: We did not find an increased risk of adverse events in patients treated with dual antiplatelet treatment beyond 1 month after endovascular procedure, supporting the safety of intermediate-term treatment as adjunct to intra- and extracranial angioplasty and/or stent placement.