Analysis of the effect of platelet function and different doses of ticagrelor after flow diverter treatment of intracranial aneurysms.

Ticagrelor has become the standard drug for the treatment of intracranial aneurysms (IAs) with flow diverters (FDs), but the dosage has not been standardized. The effect of platelet function on clinical and imaging prognosis remains unclear. This study aimed to show the effects of different doses of ticagrelor and platelet aggregation function on the clinical and imaging prognosis after FDs treatment of aneurysms. Patients with IAs and underwent FDs stenting were recruited between July 2019 and June 2023. Logistic regression was performed to assess the predictors of incomplete occlusion and in-stent stenosis (ISS). Linear regression analysis, scatter plot and violin diagram were used to investigate the predictors of maximum platelet aggregation rate induced by ADP (ADP-MPA). The study included 156 patients with 206 aneurysms. There was no significant difference in clinical prognosis and aneurysm occlusion rates between the standard-dose group (ticagrelor, 90 mg/bid) and the low-dose group (ticagrelor, 45 mg/bid). Multivariable analysis identified the ADP-MPA ≥ ADP-MPA (median) (24.2%) (p = 0.037) as an independent risk factor for incomplete occlusion of aneurysms. In addition, higher ADP-MPA (p = 0.045) was an independent risk factor for ISS. Uric acid level (p = 0.019) was negatively associated with ADP-MPA, whereas age (p = 0.031) and body mass index (BMI) (p = 0.042) were positively associated with ADP-MPA. The differences of clinical prognosis and aneurysm occlusion rates between the standard-dose group and the low-dose group were not significant for the treatment of aneurysms with FDs. Higher ADP-MPA predicted higher rates of incomplete occlusion and in-stent stenosis. Uric acid level was negatively associated with ADP-MPA, whereas age and BMI were positively associated with ADP-MPA.