• Man-Man Yi, Hong Phuoc Do, Yi-Chen Li, Rong Wang, Zong Zhuang, Man-Man Xu, Tao Liu, Teng-Fei Shao, Lan-Ping Ding, and Wei-Hong Ge.
• Nanjing Drum Tower Hospital, China Pharmaceutical University, Nanjing, China; School of Basic Medicine and Clinical Pharmacy, China Pharmaceutical University, Nanjing, China; Department of Pharmacy, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China; Department of Neurosurgery, the Drum Tower Hospital Affiliated to the Medical School of Nanjing University, Nanjing, China; Nanjing Clinical Pharmacy Center, Nanjing, China.
• World Neurosurg. 2023 Feb 1; 170: e755e765e755-e765.

BackgroundDual antiplatelet therapy (DAPT) of aspirin plus clopidogrel is commonly used in patients with unruptured intracranial aneurysms treated with stent-assisted coil (SAC) embolization. However, the unpredictable clopidogrel efficacy of the 5%-55% nonresponders limits its use. Ticagrelor, as a potential alternative of clopidogrel, is an antiplatelet agent with low resistance rates but uncertain efficacy and safety in these patients.MethodsA single-center cohort study was performed to compare the efficacy and safety of ticagrelor with clopidogrel in the DAPT regimen in patients with unruptured intracranial aneurysms and treated with SAC. The patients with clopidogrel resistance identified as inadequate adenosine diphosphate inhibition rate determined by thromboelastography were treated with ticagrelor instead, and both drugs achieved adequate suppression of platelet aggregation when stents were implanted. The occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) and bleeding events was recorded through 6 months follow-up.ResultsData from 86 patients with 99 unruptured intracranial aneurysms and treated by SAC with clopidogrel were compared with those from 108 patients with 111 aneurysms and treated with ticagrelor. Neither the baseline characteristics nor the incidence of the MACCE or bleeding events differed between the groups. Ticagrelor exerted significantly higher adenosine diphosphate inhibition rate than that of the clopidogrel. Multivariable logistic regression analysis showed that the incidence of MACCE was related to hematocrit and fibrinogen levels.ConclusionsTicagrelor seemed to be as effective and safe as clopidogrel for SAC in unruptured intracranial aneurysms. Hematocrit and fibrinogen levels were independent risk factors for the incidence of MACCE.Copyright © 2022 Elsevier Inc. All rights reserved.

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