Hyperacute in-Stent Thrombosis Causing Large Vessel Occlusion after Stent-Assisted Aneurysm Coiling Secondary to Complete Clopidogrel and Prasugrel Resistance: a Case Report

Xian, Elissa; Morrison, Thomas B.; Wong, Johnny

doi:10.1055/a-1877-0421

Cited by 2 publications

(1 citation statement)

References 10 publications

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“…A recent study demonstrated the efficacy of thromboelastography-platelet mapping in stent-assisted coiling for ruptured aneurysms, which would allow for an individualized antiplatelet regimen [ 57 ]. This would help prevent thromboembolic complications from occurring in those with antiplatelet resistance [ 58 ]. The choice for DAPT in SAC should consider the patient’s risk of bleeding, history of noncompliance, and individual drug metabolism.…”

Section: Discussionmentioning

confidence: 99%

Trends in Dual Antiplatelet Therapy Use for Neurointerventional Procedures for the Management of Intracranial Aneurysms

et al. 2023

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The use of periprocedural dual antiplatelet therapy (DAPT) has significantly evolved along with innovations in the endovascular management of intracranial aneurysms. Historically, aspirin and clopidogrel have been the most commonly employed regimen due to its safety and efficacy. However, recent studies highlight the importance of tailoring DAPT regimens to individual patient characteristics which may affect clopidogrel metabolism, such as genetic polymorphisms. In the present report, a systematic review of the literature was performed to determine optimal antiplatelet use with flow diverting stents, intracranial stents, intrasaccular devices, and stent-assisted coiling. Studies were analyzed for the number of aneurysms treated, DAPT regimen, and any thromboembolic complications. Based on inclusion criteria, 368 studies were selected, which revealed the increasing popularity of alternative DAPT regimens with the aforementioned devices. Thromboembolic or hemorrhagic complications associated with antiplatelet medications were similar across all medications. DAPT with ticagrelor, tirofiban, or prasugrel are effective and safe alternatives to clopidogrel and do not require enzymatic activation. Further clinical trials are needed to evaluate different antiplatelet regimens with various devices to establish highest-level evidence-based guidelines and recommendations.

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Section: Discussionmentioning

confidence: 99%