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Antiplatelet Therapy in Flow Diversion

Dual antiplatelet therapy is typically employed as a means to mitigate thromboembolic complications after deployment of flow diverters, most commonly consisting of aspirin with either clopidogrel, prasugrel, or ticagrelor. Recent studies have demonstrated at least similar efficacy for ticagrelor as compared to clopidogrel in the form of periprocedural complications and angiographic results. Though controversial, systematic reviews of platelet function assay usage have demonstrated greater rates of thrombotic complications in antiplatelet hyporesponders and greater rates of hemorrhagic complications in hyperresponders. Though in its infancy, the management of antiplatelet therapy for acutely ruptured aneurysms treated with flow diversion is not yet standardized, with approaches including intravenous glycoprotein IIb-IIIa inhibitors and subsequent antiplatelet loading vs antiplatelet loading, response assessment, and subsequent treatment 1).


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2: Mohanty A, Srivatsan A, Kan P. Commentary: Antiplatelet Therapy in Flow Diversion. Neurosurgery. 2020 Feb 1;86(2):E229-E230. doi: 10.1093/neuros/nyz458. PubMed PMID: 31844903.

3: Wipplinger C, Griessenauer CJ. Commentary: Antiplatelet Therapy in Flow Diversion. Neurosurgery. 2020 Feb 1;86(2):E231-E233. doi: 10.1093/neuros/nyz462. PubMed PMID: 31844900.

5: Adeeb N, Ogilvy CS, Griessenauer CJ, Thomas AJ. Expanding the Indications for Flow Diversion: Treatment of Posterior Circulation Aneurysms. Neurosurgery. 2020 Jan 1;86(Supplement_1):S76-S84. doi: 10.1093/neuros/nyz344. PubMed PMID: 31838535.

6: Kan P, Sweid A, Srivatsan A, Jabbour P. Expanding Indications for Flow Diverters: Ruptured Aneurysms, Blister Aneurysms, and Dissecting Aneurysms. Neurosurgery. 2020 Jan 1;86(Supplement_1):S96-S103. doi: 10.1093/neuros/nyz304. PubMed PMID: 31838529.

7: Maragkos GA, Thomas AJ. Commentary: Antiplatelet Therapy in Flow Diversion. Neurosurgery. 2020 Jan 1;86(Supplement_1):S53-S54. doi: 10.1093/neuros/nyz416. PubMed PMID: 31838525.

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11: Abdennour L, Sourour N, Drir M, Premat K, Shotar E, Taylor G, Godier A, Mathout J, Lenck S, Bernard R, Carpentier A, Degos V, Clarençon F. Preliminary Experience with Cangrelor for Endovascular Treatment of Challenging Intracranial Aneurysms. Clin Neuroradiol. 2019 Jul 15. doi: 10.1007/s00062-019-00811-2. [Epub ahead of print] PubMed PMID: 31309241.

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13: Limaye K, Zanaty M, Hudson J, Nakagawa D, Al Kasab S, Alvarez C, Dandapat S, Kung DK, Ortega-Gutierrez S, Jabbour P, Samaniego EA, Hasan D. The Safety and Efficacy of Continuous Tirofiban as a Monoantiplatelet Therapy in the Management of Ruptured Aneurysms Treated Using Stent-Assisted Coiling or Flow Diversion and Requiring Ventricular Drainage. Neurosurgery. 2019 Dec 1;85(6):E1037-E1042. doi: 10.1093/neuros/nyz226. PubMed PMID: 31298301.

14: Bender MT, Zarrin DA, Jiang B, Campos JK, Lin LM, Young R, Colby GP, Coon AL. Aspirin Monotherapy in Flow Diversion of Selected Internal Carotid Artery Aneurysms. World Neurosurg. 2019 Jun 26. pii: S1878-8750(19)31815-7. doi: 10.1016/j.wneu.2019.06.161. [Epub ahead of print] PubMed PMID: 31254705.

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16: Sindeev S, Prothmann S, Frolov S, Zimmer C, Liepsch D, Berg P, Kirschke JS, Friedrich B. Intimal Hyperplasia After Aneurysm Treatment by Flow Diversion. World Neurosurg. 2019 Feb;122:e577-e583. doi: 10.1016/j.wneu.2018.10.107. Epub 2018 Oct 26. PubMed PMID: 31108073.

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18: Ajadi E, Kabir S, Cook A, Grupke S, Alhajeri A, Fraser JF. Predictive value of platelet reactivity unit (PRU) value for thrombotic and hemorrhagic events during flow diversion procedures: a meta-analysis. J Neurointerv Surg. 2019 Nov;11(11):1123-1128. doi: 10.1136/neurintsurg-2019-014765. Epub 2019 Apr 20. PubMed PMID: 31005859.

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22: Girdhar G, Ubl S, Jahanbekam R, Thinamany S, Belu A, Wainwright J, Wolf MF. Thrombogenicity assessment of Pipeline, Pipeline Shield, Derivo and P64 flow diverters in an in vitro pulsatile flow human blood loop model. eNeurologicalSci. 2019 Jan 8;14:77-84. doi: 10.1016/j.ensci.2019.01.004. eCollection 2019 Mar. PubMed PMID: 30723811; PubMed Central PMCID: PMC6350389.

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25: Wagner KM, Srinivasan VM, Srivatsan A, Ghali MGZ, Thomas AJ, Enriquez-Marulanda A, Alturki AY, Ogilvy CS, Mokin M, Kuhn AL, Puri A, Grandhi R, Chen S, Johnson J, Kan P. Outcomes after coverage of lenticulostriate vessels by flow diverters: a multicenter experience. J Neurosurg. 2019 Jan 11:1-8. doi: 10.3171/2018.8.JNS18755. [Epub ahead of print] PubMed PMID: 30641842.

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36: Bender MT, Colby GP, Lin LM, Jiang B, Westbroek EM, Xu R, Campos JK, Huang J, Tamargo RJ, Coon AL. Predictors of cerebral aneurysm persistence and occlusion after flow diversion: a single-institution series of 445 cases with angiographic follow-up. J Neurosurg. 2018 Mar 30;130(1):259-267. doi: 10.3171/2017.11.JNS171738. PubMed PMID: 29600915.

37: Adeeb N, Gupta R, Schneider AM, Leadon M, Enriquez A, Griessenauer CJ, Salem M, Alturki A, Schmalz P, Ogilvy CS, Thomas AJ, Moore JM. Defining a Clopidogrel Response Cut-Off Value Using Light Transmission Aggregometry Before Pipeline Embolization of Unruptured Intracranial Aneurysms. World Neurosurg. 2018 May;113:e146-e152. doi: 10.1016/j.wneu.2018.01.198. Epub 2018 Feb 6. PubMed PMID: 29425984.

38: Orlov K, Kislitsin D, Strelnikov N, Berestov V, Gorbatykh A, Shayakhmetov T, Seleznev P, Tasenko A. Experience using pipeline embolization device with Shield Technology in a patient lacking a full postoperative dual antiplatelet therapy regimen. Interv Neuroradiol. 2018 Jun;24(3):270-273. doi: 10.1177/1591019917753824. Epub 2018 Jan 29. PubMed PMID: 29378449; PubMed Central PMCID: PMC5967181.

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48: Taylor LI, Dickerson JC, Dambrino RJ, Kalani MYS, Taussky P, Washington CW, Park MS. Platelet testing in flow diversion: a review of the evidence. Neurosurg Focus. 2017 Jun;42(6):E5. doi: 10.3171/2017.3.FOCUS1746. PubMed PMID: 28565991.

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Tonetti DA, Jankowitz BT, Gross BA. Antiplatelet Therapy in Flow Diversion. Neurosurgery. 2020 Jan 1;86(Supplement_1):S47-S52. doi: 10.1093/neuros/nyz391. PubMed PMID: 31838537.
antiplatelet_therapy_in_flow_diversion.txt · Last modified: 2020/02/05 17:29 by administrador