Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

Fujii, Takashi; Oishi, Hidenori; Teranishi, Kohsuke; Yatomi, Kenji; Suzuki, Katsushi; Arai, Hajime

doi:10.1177/1591019920947878

Cited by 8 publications

(16 citation statements)

References 34 publications

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“…However, there is some evidence that more robust anticoagulation regimens can increase nonocclusion rates without additional clinical benefit. A limited retrospective study comparing patients on additional oral anticoagulants plus DAPT versus DAPT alone prior to flow diverter placement demonstrated that the complete obliteration rate of the excluded aneurysm was significantly lower in the oral anticoagulant group [11] , in keeping with our report.…”

Section: Discussionsupporting

confidence: 90%

A case of recurrent aneurysm resulting from dual antiplatelet plus anticoagulation after confirmed aneurysm closure following coil-assisted flow diversion

Geisbush

Pulli²,

Wolman

et al. 2022

Radiology Case Reports

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Section: Discussionsupporting

confidence: 90%

A case of recurrent aneurysm resulting from dual antiplatelet plus anticoagulation after confirmed aneurysm closure following coil-assisted flow diversion

Geisbush

Pulli²,

Wolman

et al. 2022

Radiology Case Reports

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“…We previously reported that anticoagulant medication causes reduced occlusion rate after FD implantation. 32) In particular, atrial fibrillation is a disease that increases with age, so we need to be cautious about anticoagulant therapy. In the present study, 2 patients from the group of patients who had undergone previous anticoagulation therapy were included in the current long-term follow-up group.…”

Section: Discussionmentioning

confidence: 99%

Long-term Follow-up Results after Flow Diverter Therapy Using the Pipeline Embolization Device for Large or Giant Unruptured Internal Carotid Artery Aneurysms: Single-center Retrospective Analysis in the Japanese Population

Fujii

Teranishi

Yatomi

et al. 2022

Neurol. Med. Chir.(Tokyo)

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Flow diverter (FD) therapy using Pipeline embolization device (PED) has become an important alternative to treat internal carotid artery (ICA) aneurysms. Herein, we report the long-term outcome for 3 years after FD therapy using PED for ICA aneurysms in Japan. The patients who underwent angiographical and/or clinical follow-up for 3 years after the FD therapy using PED of large or giant unruptured ICA aneurysms from December 2012 at our university hospital are the subjects of this study. We retrospectively reviewed the in-and outpatients' medical charts, and written operative and radiological records. There were 84 patients with 90 aneurysms who could be clinically and/or angiographically followed up for 3 years. Of these, 7 aneurysms were only available for clinical follow-up. Of the remaining 83 aneurysms, 6 aneurysms had vessel occlusion due to stent thrombosis or parent artery occlusion, and 60 of the remaining 77 (77.9%) had complete occlusion. In multivariate analysis, older age (>70 years), wide neck, and non-adjunctive coiling contributed statistically significantly to incomplete occlusion. Of the 84 patients, 2 patients (2.4%) had delayed complications between 6 months and 3 years after the initial FD placement. Three patients (3.6%) had poor outcome due to postoperative major stroke complications, 2 of which were acute complications. The long-term results after FD therapy are good both angiographically and clinically. Endothelialization of the aneurysmal neck and intra-aneurysmal thrombosis contribute to complete occlusion. The primary reason for the somewhat low complete occlusion in Japan may be the patients are generally older.

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“…The other, for the first 6 months, was on dual antiplatelet therapy without oral anticoagulation before stopping the antiplatelets and resuming oral anticoagulation. Even worse radiographic outcomes were reported by Fujii et al 14…”

Section: Discussionmentioning

confidence: 81%

“…A single case series from the group at Juntendo University reported on eight patients undergoing flow diverting embolization of their cerebral aneurysms while on triple therapy of an oral anticoagulant and dual antiplatelet therapy. 14 While making no comment on systemic hemorrhagic complications, two of the eight treated patients suffered an intracranial hemorrhagic complication with delayed aneurysm rupture. In addition, six of the eight patients had continued filling of their aneurysms at last follow-up.…”

Section: Discussionmentioning

confidence: 99%

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Treatment of cerebral aneurysms with flow diversion or stent assisted coiling in patients on concurrent oral anticoagulation

et al. 2022

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Background Flow diversion and stent assisted coiling are increasingly utilized strategies in the endovascular treatment of cerebral aneurysms. Ischemic and hemorrhagic complications play an important role in the outcome following such embolizations. Little is published regarding patients on concurrent oral anticoagulation and undergoing such embolizations and the rates of complications and patient outcomes. Materials and Methods Retrospective data for consecutive patients on concurrent oral anticoagulation undergoing flow diversion or stent assisted coiling for cerebral aneurysms was accessed from databases at the participating sites. Patient demographics, comorbidities, antiplatelet regimens, aneurysm characteristics, complications, and radiographic results were recorded and descriptive statistics reported. Results Eleven patients were identified undergoing embolization in the setting of preoperative anticoagulant use and included seven patients undergoing flow diversion and four patients undergoing stent assisted coiling. There was a wide range of antiplatelet and anticoagulant management strategies. There were four major complications in three patients (27.2%) to include two serious bleeding events in addition to ischemic strokes. Both serious bleeding events occurred in patients continued on oral anticoagulation with the addition of antiplatelets. At a mean follow-up of 9.6 months, three aneurysms had continued filling for a good radiographic outcome of 72.7%. Conclusions Anticoagulant and antiplatelet use in the setting of flow diversion or stent assisted coiling may carry increased risks as compared to historical norms and, for flow diversion, offer decreased efficacy.

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Outcome of flow diverter placement for intracranial aneurysm with dual antiplatelet therapy and oral anticoagulant therapy

Cited by 8 publications

References 34 publications

A case of recurrent aneurysm resulting from dual antiplatelet plus anticoagulation after confirmed aneurysm closure following coil-assisted flow diversion

A case of recurrent aneurysm resulting from dual antiplatelet plus anticoagulation after confirmed aneurysm closure following coil-assisted flow diversion

Long-term Follow-up Results after Flow Diverter Therapy Using the Pipeline Embolization Device for Large or Giant Unruptured Internal Carotid Artery Aneurysms: Single-center Retrospective Analysis in the Japanese Population

Treatment of cerebral aneurysms with flow diversion or stent assisted coiling in patients on concurrent oral anticoagulation

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