Abstract Background and aims Patients with unruptured intracranial aneurysms (UIAs) and comorbid coronary artery disease or cerebral infarction carry substantial vulnerability to mid-term ischemic events. This study aimed to evaluate the secondary prevention effect of different aneurysm management strategies, treating the antithrombotic exposure mandated by stent-assisted coiling (SAC) with prolonged dual antiplatelet therapy (DAPT) as the principal mechanism of interest, and assessing whether this regimen confers superior mid-term systemic ischemic protection compared with surgical clipping (SC) or simple coiling. Methods We retrospectively analyzed 1,954 consecutive UIA patients with systemic vascular risk factors. Treatment exposures were categorized into: SC (n=611, reference), simple coiling (n=338), and SAC (STENT-based, n=1,005). The primary outcome was the 6-month ischemic cardio-cerebrovascular event rate, representing mid-term systemic ischemic vulnerability under each treatment-associated antithrombotic exposure. Baseline demographics, vascular comorbidities, and aneurysm characteristics were summarized using descriptive statistics. Mid-term risk associations were evaluated using independently refitted propensity-balanced matched cohorts for treatment-specific exposure contrasts. Results Compared with the SC reference exposure, the 6-month ischemic CCVE risk was lowest under STENT-based/DAPT exposure (3.6%), followed by COIL-only exposure (9.7%), and highest under surgical clipping exposure (22.4%), demonstrating a sustained mid-term ischemic risk gradient consistent with a treatment-associated risk-modifying signal favoring prolonged DAPT exposure. Conclusions Among UIA patients with systemic cardio-cerebrovascular diseases, prolonged DAPT exposure mandated by stent-assisted coiling exhibited the strongest mid-term systemic ischemic risk reduction signal, supporting its potential role as a treatment-associated secondary prevention strategy beyond localized aneurysm exclusion alone. Conflict of interest YINGCHAO HE: nothing to disclose. YINZHOU WANG: nothing to disclose. Table 1 - belongs to Results
He et al. (Fri,) studied this question.