Early Termination versus Standard Regimen Duration of Dual Antiplatelet Therapy in Intracranial Aneurysm Patients Treated With Pipeline Embolization Device Flex With Shield Technology: Preliminary Experience of 3 U.S. Centers

Jaims Lim; Andre Monteiro; Gustavo M Cortez; Victor H Benalia; Ammad A Baig; Wady T Jacoby; Brianna M Donnelly; Bennett R Levy; Vinay Jaikumar; Jason M Davies; Kenneth V Snyder; Adnan H Siddiqui; Ricardo A Hanel; Elad I Levy; Kunal Vakharia

doi:10.1016/j.wneu.2023.07.101

Early Termination versus Standard Regimen Duration of Dual Antiplatelet Therapy in Intracranial Aneurysm Patients Treated With Pipeline Embolization Device Flex With Shield Technology: Preliminary Experience of 3 U.S. Centers

World Neurosurg. 2023 Oct:178:e465-e471. doi: 10.1016/j.wneu.2023.07.101. Epub 2023 Jul 27.

Authors

Affiliations

¹ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
² Baptist Health Downtown and Lyerly Neurosurgery, Jacksonville, Florida, USA.
³ George Washington University School of Medicine, Washington, District of Columbia, USA.
⁴ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
⁵ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
⁶ Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
⁷ Department of Neurosurgery, University of South Florida, Tampa, Florida, USA. Electronic address: [email protected].

PMID: 37506841
DOI: 10.1016/j.wneu.2023.07.101

Abstract

Background: Pipeline Flex Embolization Device with Shield Technology (PED-Shield) is a third-generation flow diverter with reduced thromboembolic potential. However, safety profile and dual antiplatelet therapy (DAPT) recommendations with PED-Shield is not well -established. We aim to assess the safety and complication profile with early termination of DAPT with use of PED-Shield.

Methods: Databases of 3 high-volume cerebrovascular centers were retrospectively reviewed. We identified patients with unruptured and ruptured intracranial aneurysms treated with PED-Shield. Patient demographics, aneurysm characteristics, complications, and angiographic outcomes were extracted. All patients who had early termination of DAPT, defined as <180 days, as well as standard duration were included.

Results: A total of 37 patients, totaling 37 aneurysms, had early termination of DAPT and 24 patients with 24 aneurysms received standard duration (>180 days) of DAPT. There was no difference in pre-procedural DAPT regimens between the groups (P = 0.503). Following DAPT termination, o1ne major thromboembolic complication was observed in the early termination group while no major or minor thromboembolic or hemorrhagic complication was noted in the standard duration group. Time of angiographic follow-up was not statistically different (P = 0.063) between the early termination (343 days, interquartile range [IQR] 114-371 days) and the standard duration (175 days, IQR 111-224.5 days) groups. There were no statistically significant differences in complete aneurysm occlusion (P = 0.857), residual neck (P = 0.582), and aneurysm remnant (P = 0.352) rates between the groups on angiography.

Conclusions: Early termination of DAPT proves safe after PED-Shield treatment of intracranial aneurysms with comparable complete occlusion rates.

Keywords: Aneurysm; Aneurysm treatment; Flow diversion; Intracranial aneurysm; PED; PED-Shield; Pipeline flow diversion.

MeSH terms

Aneurysm, Ruptured* / diagnostic imaging
Aneurysm, Ruptured* / etiology
Aneurysm, Ruptured* / therapy
Embolization, Therapeutic*
Humans
Intracranial Aneurysm* / diagnostic imaging
Intracranial Aneurysm* / etiology
Intracranial Aneurysm* / therapy
Platelet Aggregation Inhibitors / therapeutic use
Retrospective Studies
Treatment Outcome

Substances

Platelet Aggregation Inhibitors