• World Neurosurg · Oct 2023

    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 United States 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, and Kunal Vakharia.
    • 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.
    • World Neurosurg. 2023 Oct 1; 178: e465e471e465-e471.

    BackgroundPipeline 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.MethodsDatabases 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.ResultsA 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.ConclusionsEarly termination of DAPT proves safe after PED-Shield treatment of intracranial aneurysms with comparable complete occlusion rates.Copyright © 2023 Elsevier Inc. All rights reserved.

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