Dual Antiplatelet Therapy Combining Aspirin and Ticagrelor for Intracranial Stenting Procedures: A Retrospective Single Center Study of 154 Consecutive Patients With Unruptured Aneurysms. Issue 1 (26th February 2018)

• Record Type: Journal Article
• Authors: Narata, Ana Paula; Amelot, Aymeric; Bibi, Richard; Herbreteau, Denis; Angoulvant, Denis; Gruel, Yves; Janot, Kevin
• Is Part Of: Neurosurgery. Volume 84:Issue 1(2019)
• Page Start: 77
• Page End: 83
• Publication Date: 2018-02-26
• Subjects: Anti-platelet therapy -- Intracranial aneurysm -- Intracranial stent -- Ticagrelor; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy002
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Dual antiplatelet therapy (DAPT) associating aspirin + clopidogrel is commonly utilized in neurovascular interventions despite unpredictable clopidogrel efficacy with 4% to 50% of patients considered nonresponders. Ticagrelor is an antiplatelet agent with low resistance rates but unknown efficacy and safety in neurovascular patients. OBJECTIVE: To evaluate frequency of ischemic and hemorrhagic events in patients treated with aspirin and ticagrelor when associated with perioperative heparin bolus for unruptured aneurysms treated with intracranial stents. METHODS: One hundred fifty-four consecutive patients with unruptured intracranial aneurysms treated by stent procedures (113 = flow diverter stent [FDS], 41 = stent-assisted coiling) were retrospectively analyzed. All patients received aspirin and ticagrelor without platelet function testing. Patients were separated in 2 groups following perioperative heparin dose: group I = 70 U/kg; group II = 50 U/kg. FDS versus stent-assisted coiling procedures were also separately analyzed. RESULTS: Nine patients (5.8%) presented symptomatic neurological complications poststenting (3 ischemic, 6 hemorrhagic): 8 patients received 70 U/kg of heparin (11.1%) and 1 patient received 50 U/kg (1.2%; P < .009). Four patients died (2.6%) during the 3-mo follow-up period—all deaths were correlated to intracranial hemorrhage: 3 at group I and 1 at group II ( P < .251). No difference in complications or death was observed considering separately FDS and stent-assisted coiling procedures. CONCLUSION: This study did not find more neurological complications than in previous neurointerventional reports using DAPT with aspirin + ticagrelor or aspirin + clopidogrel. Overall number of neurological complications was lower when a lower dose of heparin was administered. Neurovascular studies comparing clopidogrel to ticagrelor and different doses of heparin are necessary to demonstrate which association is more efficient with lower complication rates.