Endovascular complications: Antiplatelet managementfor flow diversion
Journal Title: BOHR International Journal of Neurology and Neuroscience - Year 2024, Vol 2, Issue 1
Abstract
Up to 3−5% of the general population is affected by cerebral aneurysms that are associated with both modifiableas well as non-modifiable risk factors ranging from familial to acquired neurovascular conditions. The initialtreatment option was aneurysm clipping and evolved to including primary or adjuvant endovascular treatment.Aneurysm re-rupture, although rare, can have devastating consequences such as intracranial bleeding and carotid-cavernous fistula. Emergent surgery in view of delayed aneurysm rupture in patients maintained on dual antiplatelettherapy presents with the need to carefully assess the procedure-related risk factors and evaluate the patients’platelet function. With the advent of novel technology, flow diverters came into play. These devices utilize thedeployment of metallic stents into the parent artery that serves the diversion of blood flow away from thepouching aneurysm. Despite their efficacy, flow diverter insertion and catheter manipulation come with a riskof developing ischemia and stroke, hemorrhage and aneurysm re-rupture, in-stent thrombosis and stenosis, andaneurysmal occlusion amongst other complications. The prospect of thromboembolic events necessitates the useof aggressive antiplatelet regimen with the dual antiplatelet regimen utilizing clopidogrel and aspirin used mostfrequently. Prasugrel and Ticagrelor have been shown to be superior to Clopidogrel in terms of thromboembolicconsequences in cardiovascular literature. Given their potential benefit over the current standard of treatment in thispatient population, more extensive randomized-controlled studies are warranted for the evaluation of the efficacyand non-inferiority of Prasugrel and Aspirin or Ticagrelor and Aspirin to Clopidogrel and Aspirin.
Authors and Affiliations
Abdurrahman F. Kharbat, Michael Chukwu, Zaira Khalid, Faisal Alamri, Ryan Morgan, EhsaunHeydari, Abigail York, Ian Camp1and Brandon Lucke-Wold
Keywords
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- EP ID EP741989
- DOI 10.54646/bijnn.2024.13
- Views 21
- Downloads 0
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