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Modernización de la terapia antiplaquetaria dual en la desviación de flujo: resultados comparativos después de la
Pratham B Bhatt1,2, Evan McNeil1,2, Aryan Wadhwa1,2
1Neurosurgical Service, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
Journal of neurointerventional surgery
|February 11, 2026
Resumen
El prasugrel demostró una seguridad y eficacia similares en comparación con el clopidogrel y el ticagrelor para el tratamiento de desviación de flujo (FD) de aneurismas cerebrales. Se necesita más investigación para establecer protocolos óptimos de terapia antiplaquetaria dual (DAPT) para los procedimientos de FD.
Área de la Ciencia:
- La neurocirugía es la neurocirugía.
- La neuroradiología intervencionista.
- Cardiología Cardiología.
Sus antecedentes:
- La terapia antiplaquetaria dual (DAPT) es crucial para la desviación de flujo (FD), pero carece de evidencia específica para el uso intracraneal.
- La respuesta variable al clopidogrel requiere estrategias alternativas de DAPT.
- Este estudio evalúa los resultados con un enfoque DAPT universal basado en prasugrel.
Objetivo del estudio:
- Para comparar la seguridad y eficacia de clopidogrel, ticagrelor y DAPT a base de prasugrel en pacientes sometidos a FD intracraneal.
- Para evaluar las tasas de complicaciones, la oclusión del aneurisma y los resultados funcionales.
- Para investigar el impacto de la modificación de la superficie de PED en las tasas de retratamiento.
Principales métodos:
- Revisión retrospectiva de 243 procedimientos de FD utilizando el Dispositivo de Embolización de la Conducta (PED) desde julio de 2021 hasta julio de 2024.
- Análisis de los resultados primarios: complicaciones tromboembólicas / hemorrágicas, tasas de oclusión y escala de Rankin modificada (mRS).
- Análisis secundario basado en la modificación de la superficie PED y el régimen DAPT (clopidogrel, ticagrelor, prasugrel).
Principales resultados:
- El 97,8% de los pacientes logró resultados funcionales favorables (mRS ≤2) independientemente del régimen DAPT.
- Las tasas de oclusión de aneurismas fueron altas (86,4%) y similares en todos los grupos de DAPT.
- No se observaron diferencias significativas en las complicaciones tromboembólicas (4,1%) o hemorrágicas (4,9%); sin embargo, todas las hemorragias ocurrieron con ticagrelor. Las tasas de retratamiento fueron más bajas para los PED modificados superficialmente (0,9% frente a 8,3%).
Conclusiones:
- El DAPT basado en prasugrel es una opción segura y efectiva para el FD intracraneal, comparable al clopidogrel y el ticagrelor.
- Existen brechas significativas en la evidencia para la selección de DAPT en FD.
- Necesidad urgente de registros multicéntricos y ensayos prospectivos para estandarizar los protocolos DAPT para FD intracraneal.
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