Perioperative Antiplatelet Management in the Flow-Diverter Treatment for Unruptured Cerebral Aneurysms: A Single-Center, Retrospective Analysis

• Published in: World Neurosurgery Vol. 183; pp. e44 - e50
• Main Authors: Miyama, Masataka, Matsukawa, Hidetoshi, Sakakibara, Fumihiro, Uchida, Kazutaka, Shirakawa, Manabu, Yoshimura, Shinichi
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.03.2024; Elsevier BV
• Subjects: Antiplatelet; Flow diverter; Neuroendovascular; Unruptured aneurysm; EVT; ARU; Unruptured aneurysm; IQR; UIA; ADP; PED; Flow diverter; SD; Antiplatelet; PRU; DSA; FDS; SAPT; TAPT; Neuroendovascular; DAPT
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2023.10.128

Although periprocedural antiplatelet therapy for the treatment of unruptured intracranial aneurysms (UIAs) using flow-diverter stents (FDSs) is necessary to avoid thromboembolic complications, a definite antiplatelet therapy has not been established. We aimed to evaluate the safety and efficacy of periprocedural antiplatelet management in UIA treatment with FDS. A single-center retrospective analysis of consecutive patients with UIAs treated with FDSs between September 2013 and January 2022 was conducted. Patients received dual antiplatelet therapy (DAPT) (aspirin and clopidogrel) for 14-day before and 3–6 months after FDS placement. Platelet aggregation was evaluated prior to treatment using light transmission aggregometry, which was classified into 3 grades; 1–3: promoted, 4–6: appropriate, and 7–9: non-responder, for adenosine diphosphate (ADP) and collagen. By this classification, the antiplatelet regimen was modified. Outcome included hemorrhagic and ischemic events. 193 patients with 200 UIAs underwent 213 FDSs placement. The median platelet aggregability grade before treatment was 5 for ADP and 4 for collagen. Antiplatelet therapy modification was performed in 62 patients (32.1%). The median postoperative DAPT duration was 94 days. Antiplatelet medicine-related hemorrhagic events occurred in 4 patients (2.1%) and ischemic events occurred in 6 patients (3.1%). These patients had no morbido-mortality. Periprocedural antiplatelet management based on the value of platelet aggregability was relatively safe and effective for treating UIA with FDS.