Efficacy and safety of ticagrelor versus clopidogrel associated with aspirin for dual antiplatelet therapy in cerebral aneurysm stenting treatment: Monocentric cohort experience

Abstract

Background and purpose Adverse events in endovascular treatment for ruptured and unruptured cerebral aneurysms are feared particularly thromboembolic complications when stent device is used. Dual antiplatelet therapy is a standard of care but choice of appropriate association doesn’t reach any consensus in neurovascular context. Objective is to match efficiency of aspirin-clopidogrel and aspirin-ticagrelor associations in the prevention of thromboembolic complications after cerebral aneurysms stenting treatment. Methods This is a monocentric, retrospective, cohort comparison study design. We compared both groups treated with either clopidogrel or ticagrelor in association with aspirin in consecutive aneurysms protected with flow diverter embolization device or stent-assisted coiling. Data were collected on patient demographics and thromboembolic risk factors, procedural details, antiplatelet treatment regime, complications, angiographic and functional outcomes. Results One hundred and sixteen patients were treated by cerebral stenting between January 2013 and September 2017 and benefited from dual anti-agregation. Sex, age, smoking status and procedural details did not differ between the two groups. We show no difference about onset of thromboembolic complications and functional outcomes. Conclusion Aspirin and ticagrelor association in the field of interventional neuroradiology is not accepted in routine. Questions are to be solved about treatment resistance (absence of prerequisite agregability test) and hemorrhagic complications.