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Antiplatelet Therapy in Flow Diversion.

Daniel A Tonetti1, Brian T Jankowitz1, Bradley A Gross1

  • 1UPMC Stroke Institute and Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.

Neurosurgery
|December 16, 2019
PubMed
Summary

Dual antiplatelet therapy with aspirin and a P2Y12 inhibitor is standard after flow diverter placement. Ticagrelor shows comparable efficacy to clopidogrel, but optimal management for ruptured aneurysms remains under investigation.

Keywords:
AneurysmAntiplateletAntiplatelet therapyFlow diversion

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Area of Science:

  • Neuroendovascular surgery
  • Cardiology
  • Pharmacology

Background:

  • Dual antiplatelet therapy (DAPT) is crucial for preventing thromboembolic events after flow diverter (FD) placement.
  • Common DAPT regimens include aspirin with clopidogrel, prasugrel, or ticagrelor.

Purpose of the Study:

  • To evaluate the efficacy and safety of different DAPT strategies following flow diverter deployment, particularly in ruptured aneurysms.
  • To explore the role of platelet function assays in guiding DAPT and managing complications.

Main Methods:

  • Comparative analysis of studies investigating ticagrelor versus clopidogrel efficacy.
  • Review of systematic reviews on platelet function assay (PFA) utility in DAPT.
  • Examination of emerging DAPT management protocols for ruptured aneurysms treated with FDs.

Main Results:

  • Ticagrelor demonstrates efficacy comparable to clopidogrel regarding periprocedural complications and angiographic outcomes.
  • PFA use is associated with increased thrombotic risks in hyporesponders and hemorrhagic risks in hyperresponders, though its clinical utility remains debated.
  • Standardized DAPT protocols for ruptured aneurysms treated with FDs are still developing.

Conclusions:

  • Ticagrelor is a viable alternative to clopidogrel in DAPT after FD placement.
  • PFA-guided DAPT may help personalize therapy but requires further validation, especially in high-risk scenarios like ruptured aneurysms.
  • Further research is needed to standardize DAPT management for ruptured aneurysms treated with flow diversion.