Ticagrelor use in ruptured aneurysms: A retrospective cohort study

BackgroundThe acute management of ruptured intracranial aneurysms sometimes requires stent placement, which necessitates the prompt initiation of an antiplatelet (APT) regimen, including Ticagrelor at our center.ObjectiveThis study aimed to assess patients with ruptured intracranial aneurysms who received Ticagrelor prior to or during aneurysm embolization. We evaluated procedural safety and clinical and imaging outcomes at 6 months follow-up.Patients and MethodsWe analyzed patients with aneurysmal subarachnoid hemorrhage treated with endovascular therapy (EVT) under a dual antiplatelet therapy (DAPT) regimen between January 2015 and January 2023, excluding those managed with surgical clipping. Safety profiles and clinical outcomes were systematically assessed.ResultsA total of 23 patients (69.6% female, mean age 58.6 ± 12.2 years) with ruptured aneurysms and subarachnoid hemorrhage underwent EVT with DAPT (Ticagrelor + Aspirin). Aneurysms were primarily located on the carotid (39.1%) and anterior communicating arteries (30.4%), with a median size of 5 mm. The median time from rupture to treatment was 1.5 days. Ischemic complications occurred in 30.4%, including procedure-related ischemia (21.7%) and post-procedure vasospasm (8.7%). Hemorrhagic complications were observed in 8.7%, with two patients experiencing asymptomatic post-procedure hemorrhage. Functional outcomes at 6 months showed 56.5% of patients with excellent recovery (mRS <2), while 17.4% died (mRS = 6), resulting in a 17.4% mortality rate.ConclusionTicagrelor appears feasible and generally safe for acute-phase management of aneurysmal subarachnoid hemorrhage, though complications and mortality highlight the need for cautious patient selection and further investigation.