Ticagrelor use in ruptured aneurysms: A retrospective cohort study

Area of Science:

• Neurology
• Cardiology
• Interventional Radiology

Background:

• Acute management of ruptured intracranial aneurysms often requires stent placement.
• Stent placement necessitates prompt initiation of an antiplatelet (APT) regimen, including Ticagrelor.

Purpose of the Study:

• Assess safety and outcomes of Ticagrelor in patients with ruptured intracranial aneurysms undergoing embolization.
• Evaluate procedural safety, clinical, and imaging outcomes at 6-month follow-up.

Main Methods:

• Retrospective analysis of 23 patients with aneurysmal subarachnoid hemorrhage treated with endovascular therapy (EVT) and dual antiplatelet therapy (DAPT) (Ticagrelor + Aspirin).
• Exclusion of patients managed with surgical clipping.
• Systematic assessment of safety profiles and clinical outcomes.

Main Results:

• 30.4% of patients experienced ischemic complications (procedure-related ischemia, post-procedure vasospasm).
• 8.7% experienced hemorrhagic complications, including two asymptomatic post-procedure hemorrhages.
• At 6 months, 56.5% had excellent recovery (mRS <2), and 17.4% died (mRS = 6).

Conclusions:

• Ticagrelor appears feasible and generally safe for acute-phase management of aneurysmal subarachnoid hemorrhage.
• Complications and mortality underscore the need for cautious patient selection.
• Further investigation is warranted for optimizing Ticagrelor use in this patient population.