Flow Diversion in Patients With Concurrent Anticoagulation: Multicenter Experience and Systematic Review of...

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Vascular Surgery

Background:

• Dual antiplatelet therapy is standard after flow diversion (FD) to prevent thromboembolic events.
• Oral anticoagulation (AC) increases hemorrhagic risks, posing challenges for FD procedures.
• The safety and efficacy of FD in patients concurrently on AC require further investigation.

Purpose of the Study:

• To evaluate the safety and efficacy of flow diversion (FD) in patients with intracranial aneurysms who are on concurrent oral anticoagulation (AC).
• To assess outcomes including occlusion rates, complications, and functional status in this specific patient cohort.

Main Methods:

• Retrospective analysis of 19 patients (20 aneurysms) undergoing FD while on AC across 3 institutions (Jan 2018-Jan 2024).
• Systematic literature review of studies reporting FD outcomes in patients on AC.
• Outcomes assessed: angiographic occlusion (OKM Grade), postoperative complications, in-stent stenosis, and modified Rankin Scale (mRS).

Main Results:

• Complete occlusion (OKM Grade D) was achieved in 40% of aneurysms.
• 89.4% of patients were female, with a median age of 71%.
• 20% developed asymptomatic in-stent stenosis; 84.2% of patients remained functionally independent (mRS 0-2).
• Literature review showed occlusion rates from 25% to 71.4%, with increased delayed rupture and retreatment risks in AC patients.

Conclusions:

• Flow diversion in patients on concurrent oral anticoagulation is associated with lower complete aneurysm obliteration rates.
• The findings highlight the need for further research into optimal antithrombotic regimens for this population.
• Careful patient selection and monitoring are crucial when considering FD in anticoagulated patients.