Triple therapy versus dual-antiplatelet therapy for dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters

Adnan H Siddiqui; Andre Monteiro; Ricardo A Hanel; Peter Kan; Alina Mohanty; Gustavo M Cortez; Margarita Rabinovich; Charles Matouk; Nanthiya Sujijantarat; Charles Romero; Jeremy Stone; Koji Ebersole; Lane Fry; Sabareesh K Natarajan; Brittany Owusu-Adjei; Santiago Ortega-Gutierrez; Juan Vivanco-Suarez; Ajay K Wakhloo; Elad I Levy

doi:10.1136/jnis-2022-019151

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Triple therapy versus dual-antiplatelet therapy for dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters

Journal article

Peer reviewed

Triple therapy versus dual-antiplatelet therapy for dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters

Adnan H Siddiqui, Andre Monteiro, Ricardo A Hanel, Peter Kan, Alina Mohanty, Gustavo M Cortez, Margarita Rabinovich, Charles Matouk, Nanthiya Sujijantarat, Charles Romero, …

Journal of neurointerventional surgery, Vol.15(7), pp.655-663

07/2023

DOI: 10.1136/jnis-2022-019151

PMID: 36190965

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Abstract

BackgroundDolichoectatic vertebrobasilar fusiform aneurysms (DVBFAs) have poor natural history when left untreated and high morbimortality when treated with microsurgery. Flow diversion (FD) with dual-antiplatelet therapy (DAPT) is feasible but carries high risk of perforator occlusion and progression of brainstem compression. Elaborate antithrombotic strategies are needed to preserve perforator patency while vessel remodeling occurs. We compared triple therapy (TT (DAPT plus oral anticoagulation)) and DAPT alone in patients with DVBFAs treated with FD.MethodsRetrospective comparison of DAPT and TT in patients with DVBFAs treated with FD at eight US centers.ResultsThe groups (DAPT=13, TT=14) were similar in age, sex, clinical presentation, baseline disability, and aneurysm characteristics. Radial access use was significantly higher in the TT group (71.4% vs 15.3%; P=0.006). Median number of flow diverters and adjunctive coiling use were non-different between groups. Acute ischemic stroke rate during the oral anticoagulation period was lower in the TT group than the DAPT group (7.1% vs 30.8%; P=0.167). Modified Rankin Scale score decline was significantly lower in the TT group (7.1% vs 69.2%; P=0.001). Overall rates of hemorrhagic complications (TT, 28.6% vs DAPT, 7.7%; P=0.162) and complete occlusion (TT, 25% vs DAPT, 54.4%; P=0.213) were non-different between the groups. Rate of moderate-to-severe disability at last follow-up was significantly lower in the TT group (21.4% vs 76.9%; P=0.007).ConclusionsPatients with DVBFAs treated with FD in the TT group had fewer ischemic strokes, less symptom progression, and overall better outcomes at last follow-up than similar patients in the DAPT group.

Aneurysm

Flow Diverter

Hemorrhagic stroke

Intervention

Details

Title: Subtitle: Triple therapy versus dual-antiplatelet therapy for dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters
Creators: Adnan H Siddiqui - University at Buffalo, State University of New York
Andre Monteiro - Neurosurgery, Gates Vascular Institute, Buffalo, New York, USA
Ricardo A Hanel - Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
Peter Kan - Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
Alina Mohanty - Medical Student, Baylor College of Medicine, Houston, Texas, USA
Gustavo M Cortez - Lyerly Neurosurgery, Baptist Medical Center Downtown, Jacksonville, Florida, USA
Margarita Rabinovich - Neurointerventional Radiology and Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
Charles Matouk - Yale University
Nanthiya Sujijantarat - Neurosurgery, Yale University, New Haven, Connecticut, USA
Charles Romero - Great Lakes Neurosurgery and Neurointervention, UPMC Hamot, Erie, Pennsylvania, USA
Jeremy Stone - Great Lakes Neurosurgery and Neurointervention, UPMC Hamot, Erie, Pennsylvania, USA
Koji Ebersole - Neurosurgery, The University of Kansas Health System, Kansas City, Kansas, USA
Lane Fry - Neurosurgery, The University of Kansas Health System, Kansas City, Kansas, USA
Sabareesh K Natarajan - Neurosurgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
Brittany Owusu-Adjei - Neurosurgery, University of Massachusetts Chan Medical School, Worcester, Massachusetts, USA
Santiago Ortega-Gutierrez - Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Juan Vivanco-Suarez - Neurology, Neurosurgery and Radiology, The University of Iowa Hospitals and Clinics, Iowa City, Iowa, USA
Ajay K Wakhloo - Neurointerventional Radiology and Radiology, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA
Elad I Levy - Neurosurgery and Radiology and Canon Stroke and Vascular Research Center and Canon Stroke and Vascular Research Center, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
Resource Type: Journal article
Publication Details: Journal of neurointerventional surgery, Vol.15(7), pp.655-663
DOI: 10.1136/jnis-2022-019151
PMID: 36190965
NLM abbreviation: J Neurointerv Surg
ISSN: 1759-8478
eISSN: 1759-8486
Publisher: BMJ Publishing Group Ltd
Language: English
Electronic publication date: 09/07/2022
Date published: 07/2023
Academic Unit: Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984303023702771

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