Low-Dose Glucocorticoids Adjunctive to Flow Diverter Therapy for Unruptured Intracranial Aneurysms Improve Cerebrovascular Outcomes
Abstract
Abstract Flow diverter (FD) implantation is standard for unruptured intracranial aneurysms (UIAs), but cerebrovascular complications persist. This nested study within a prospective multicenter cohort evaluates whether short-term, low-dose glucocorticoid use is associated with cerebrovascular outcomes after FD implantation. Propensity-score matching with exact matching on UIA location yielded 1327 patients (360 glucocorticoid-treated; 967 controls). Intravenous glucocorticoids, initiated within 2 hours of the FD procedure and administered for ≥2 days, were associated with fewer in-hospital cerebrovascular events (6.9% vs. 13.1%; adjusted odds ratio [aOR], 0.53) and major cerebrovascular events (4.7% vs. 12.4%; aOR, 0.37). Over a median 2-year follow-up, glucocorticoid use was also associated with fewer new-onset major cerebrovascular events (3.6% vs. 8.7%; adjusted hazard ratio, 0.41) and less in-stent stenosis (7.9% vs. 13.2%; aOR, 0.55). Findings remained robust in unmatched patients on sensitivity analyses. We demonstrate that perioperative glucocorticoid regimens may reduce cerebrovascular events and in-stent stenosis in FD-treated patients, warranting randomized trials.
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Authors: Zhuohua Wen, Xiheng Chen, Xin Tong, Chi Huang, Mengshi Huang, Jiancheng Lin, Anqi Xu, Hanyan Yang, Xiru Zhang, Yuanqi Lin, Jiwan Huang, Runze Ge, Hao Yuan, Chao Peng, Yanchao Liu, Fa Jin, 苏世星, Xin Zhang, Xifeng Li, Zongduo Guo, Ming Lv, Aihua Liu, Chuan‐Zhi Duan, Xin Feng
Institutions: Southern Medical University, Capital Medical University, National Clinical Research Center for Digestive Diseases, Beijing Chao-Yang Hospital, Capital Medical University, The Affiliated Yongchuan Hospital of Chongqing Medical University, Guangdong Academy of Medical Sciences, Zhujiang Hospital, Beijing Tian Tan Hospital, Beijing Anzhen Hospital