Antitrombotica veilig bij incidentele ongescheurde intracraniële aneurysma’s na ischemisch beroerte

BACKGROUND: The coexistence of acute ischemic stroke (AIS) and unruptured intracranial aneurysms (UIAs) is relatively common, but the safety of antithrombotic therapy in this population remains uncertain. This study evaluated whether different secondary prevention regimens influence UIA progression or rupture risk. METHODS: This single-center retrospective cohort study included patients with AIS and concomitant saccular UIAs between January 2016 and December 2021. Patients were categorized according to long-term antithrombotic exposure: single antiplatelet therapy (SAPT), anticoagulation, or no regular therapy. Dual antiplatelet therapy (DAPT) was analyzed separately. The primary outcome was aneurysm rupture; secondary outcomes included symptomatic events and radiographic progression (≥1 mm growth). RESULTS: Among 197 patients (mean age 68.4 ± 10.2 years; 53.8% female), 140 received SAPT, 36 received anticoagulation, and 21 received no regular therapy. During a mean follow-up of 28.6 ± 18.4 months, aneurysm rupture occurred in two patients (1.0%). No ruptures occurred in the anticoagulation group. Firth's penalized logistic regression showed no significant association between antithrombotic regimen and aneurysm rupture (anticoagulation vs SAPT: OR 0.41, 95% CI 0.01-5.21; no therapy vs SAPT: OR 3.21, 95% CI 0.21-45.6; both p > 0.05). CONCLUSIONS: In patients with small incidental saccular UIAs and AIS, standard secondary prevention regimens were not associated with an increased risk of aneurysm rupture. However, the limited number of rupture events and potential residual confounding warrant cautious interpretation. Secondary stroke prevention should remain the priority, with individualized assessment of aneurysm-related risks.