Flow diverter stents with hydrophilic polymer coating for the treatment of acutely ruptured aneurysms using single antiplatelet therapy: Preliminary experience

Abstract

Background The use of flow diverter stent (FDS) has limitations in cases of subarachnoid haemorrhage caused by ruptured aneurysm, due to the need for double antiplatelet therapy and the delay in the aneurysm occluding. The p48 MW and the p64 MW (Phenox) are available with Hydrophilic Polymer Coating (HPC), that reduces the risk of thrombus formation. Purpose of this study is to evaluate the safety and efficacy of p48 and p64 MW HPC with single antiplatelet therapy for the acute treatment of ruptured aneurysm. Methods We retrospectively evaluated all patients treated for acutely ruptured aneurysms with a p48 MW HPC or p64 MW HPC from October 2019 to April 2020 using single antiplatelet therapy. For each patient, we considered demographic and aneurysm-related data, clinical presentation, size and location of the implanted flow diverter stent, intra- and post-procedural complications, aneurysm occlusion. Results Seven patients were included. The ruptured aneurysms were four saccular, two blister-like and one dissecting, six in the anterior and one in posterior circulation. No intraprocedural stent thrombosis and rebleeding was observed. In two cases the aneurysm is completely excluded, in one patient it was found only neck perfusion, in three cases there were mild reduction of the sac and in one case there was a persistent perfusion. No patients needed retreatment in this series. Conclusion In our experience, FDS HPC appears a potential treatment option in selected cases. Our study is limited by small population and short-term follow-up. We report our preliminary data, but further investigations are necessary.

First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating

“…The stent-carrier module of the p64MW features an independently movable wire that can be placed 6 cm distal to the stent in order to provide increased stability during placement and preserve distal access after deployment. The potentially most significant improvement is its availability with a hydrophilic polymer coating that inhibits platelet adhesion and activation, and thus allows early reduction of DAPT or even single anti-platelet therapy (SAPT) (17,(22)(23)(24)(25)(26).…”

The Woven EndoBridge for unruptured intracranial aneurysms: Results in 95 aneurysms from a single center

“…However very promising, these coated devices are still in an early stage and more research is still needed. [6][7][8][9] Many meta-analyses have been published on the use of flow diverters. 10 Morbi-mortality with flow diversion has been described with a broad range from almost 2-10% depending on the publication.…”

Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers

“…FD in acute SAH requires dual antiplatelet therapy, which delays obliteration of the aneurysm, increases the risk for re-rupture, and has been associated with a complication rate of 18% ( 36 ). In this regard, the selection of a coated device with biomimicry properties that prevent interactions with blood cells—most importantly platelets—is advantageous, as this strategy allows early reduction of platelet function inhibition or even single antiplatelet treatment ( 25 ).…”