Department of Comprehensive Strokology, Fujita Health University School of Medicine, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi, Japan.
Clin Neuroradiol. 2024 Mar;34(1):201-208. doi: 10.1007/s00062-023-01355-2. Epub 2023 Oct 17.
Prasugrel is not approved for patients treated with flow diverters, which have a high metal coverage ratio. However, robust antiplatelet therapy with prasugrel may prevent thromboembolic complications. We administered prasugrel and aspirin to all patients treated with flow diverters and reported the safety of the antiplatelet therapy regimen.
This retrospective, single-center study evaluated the angiographic and clinical data of consecutive patients treated with flow diverters for cerebral unruptured aneurysms between June 2020 and May 2022. All patients received dual antiplatelet therapy, including prasugrel and aspirin. The administration of prasugrel ended 3 or 6 months after the procedure, whereas aspirin use continued for at least 12 months. Periprocedural complications (< 30 days post-procedure) and delayed complications (> 30 days post-procedure) were recorded.
During the study period, 120 unruptured aneurysms were treated with flow diverters in 110 patients. All patients, except one, survived longer than 12 months after the procedure. The rate of thromboembolic complications was 6.4%, and more than half of the patients had transient symptoms; one (0.9%) had a major ischemic stroke. One patient (0.9%) each had an asymptomatic, small subarachnoid hemorrhage and significant hemorrhagic complications with melena. The rate of permanent neurological deficits was 1.8%, and the mortality rate was 0.9%.
Dual antiplatelet therapy comprising routine use of prasugrel and aspirin for flow diverter-implanted patients possibly contributed to a low rate of thromboembolic complications and low risk of hemorrhagic complications.
普拉格雷不适用于接受高金属覆盖率血流导向装置治疗的患者。然而，使用普拉格雷进行强有力的抗血小板治疗可能会预防血栓栓塞并发症。我们对所有接受血流导向装置治疗的患者使用了普拉格雷和阿司匹林，并报告了该抗血小板治疗方案的安全性。
这项回顾性、单中心研究评估了 2020 年 6 月至 2022 年 5 月期间连续接受血流导向装置治疗的脑未破裂动脉瘤患者的血管造影和临床数据。所有患者均接受双联抗血小板治疗，包括普拉格雷和阿司匹林。普拉格雷的给药在术后 3 或 6 个月结束，而阿司匹林的使用至少持续 12 个月。记录围手术期并发症（术后<30 天）和迟发性并发症（术后>30 天）。
在研究期间，110 例患者中有 120 个未破裂动脉瘤接受了血流导向装置治疗。除 1 例患者外，所有患者在手术后 12 个月以上存活。血栓栓塞并发症的发生率为 6.4%，且半数以上患者有短暂症状；1 例（0.9%）发生大的缺血性中风。1 例（0.9%）患者分别出现无症状的小蛛网膜下腔出血和伴有黑便的显著出血性并发症。永久性神经功能缺损的发生率为 1.8%，死亡率为 0.9%。
常规使用普拉格雷和阿司匹林进行双联抗血小板治疗可能有助于降低血栓栓塞并发症的发生率和出血性并发症的风险。
