Safety and efficacy of ticagrelor as single antiplatelet therapy in prevention of thromboembolic complications associated with the Pipeline Embolization Device (PED): multicenter experience

Abstract

BackgroundFlow diversion (FD) is a common treatment modality for complex intracranial aneurysms. A major concern regarding the use of FD is thromboembolic events (TEE). There is debate surrounding the optimal antiplatelet regimen to prevent TEE. We aim to evaluate the safety and efficacy of ticagrelor as a single antiplatelet therapy (SAPT) for the prevention of TEE following FD for complex aneurysm treatment.MethodsA retrospective review of a prospectively maintained neuroendovascular database at three endovascular centers was performed. Patients were included if they had an intracranial aneurysm that was treated with FD between January 2018 and September 2019 and were treated with ticagrelor as SAPT. Primary outcomes included early (within 72 hours post-procedure) and late (within 6 months) ischemic events.ResultsA total of 24 patients (mean age 47.7 years) with 36 aneurysms were eligible for analysis, including 15 (62.5%) females. 14 (58.3%) patients presented with subarachnoid hemorrhage. 35 aneurysms arose from the anterior circulation and 1 from the posterior circulation. 23 aneurysms had a saccular morphology, whereas 7 were fusiform and 6 were blister. For the treatment of all 36 aneurysms, 30 procedures were performed with 32 FD devices. Procedural in-stent thrombosis occurred in 2 cases and was treated with intra-arterial tirofiban without complications. Aneurysm re-bleeding was reported in 1 (4.2%) patient. There were no reported early or late TEE. Three patients discontinued ticagrelor due to systemic side effects.ConclusionTicagrelor is a safe and effective SAPT for the prevention of TEE after FD. Large multicenter prospective studies are warranted to validate our findings.

Early Treatment of Ruptured Blood Blister-Like Aneurysms of the Internal Carotid Artery With Flow Diverters Using Single Antiplatelet Therapy: A Single-Center Experience With Long-Term Follow-Up

“…SAPT use with FD treatment is a new approach, and limited data are available in the literature. In a recent study, ticagrelor was used to prevent thromboembolic complications with Pipeline device (PED) as SAPT ( 10 ). Mohammaden et al demonstrated ticagrelor as a safe and effective antiplatelet in ruptured aneurysms with FDs.…”

“…However, hemorrhagic complications are a major concern during DAPT treatment in the acute setting of SAH. There have been limited data obtained from previous studies on single antiplatelet therapy (SAPT) in preventing thromboembolic complications associated with FDs ( 10 ). New-generation P2Y12 antagonist (ticagrelor and prasugrel) usage in neurointervention is a novel topic ( 11 ).…”

Intracranial Fusiform and Circumferential Aneurysms of the Main Trunk: Therapeutic Dilemmas and Prospects

“…For the application of FD application for IFCAs, the use of telescoping FDs with 25-30% overlap is often required to cover the entire IFCA (45). In addition, overlapping FDs can be employed for a greater flow-diverting effect (46). For this purpose, the new-generation double-layered FD is more useful (47).…”

“…For this purpose, the new-generation double-layered FD is more useful (47). However, this strategy must be used cautiously to avoid ischemia from perforator occlusion, especially in the BA or MCA (46,48). As a reconstructive technique, on rare occasions, it is necessary to combine FD deployment with the deconstructive approach.…”

Endovascular treatment of type 1 and type 4 non-saccular aneurysms of cerebral arteries – a single-Centre experience

“…Additionally, unlike clopidogrel or prasugrel, this drug does not require metabolic transformation, and receptor blockade generated by this drug is reversible. 17…”