Aneurysm Treatment in Acute SAH with Hydrophilic-Coated Flow Diverters under Single-Antiplatelet Therapy: A 3-Center Experience

Abstract

BACKGROUND AND PURPOSE: In certain clinical circumstances, dual-antiplatelet therapy can be problematic in patients with acute SAH. In some aneurysms, however, flow-diverting stents are the ideal therapeutic option. We report our experience with ruptured intracranial aneurysms treated with flow diverters with hydrophilic coating (p48 MW HPC and p64 MW HPC) under single-antiplatelet therapy.MATERIALS AND METHODS: Patients were treated with either flow-diverter placement alone or a flow diverter and additional coiling. Due to the severity of the hemorrhage, the potential for periprocedural rehemorrhage, and the potential for additional surgical interventions, a single-antiplatelet regimen was used in all patients.RESULTS: Thirteen aneurysms were treated in 10 patients. The median age was 62 years; 5 patients were male. All had acute SAH due to aneurysm rupture. Four blood-blister, 2 dissecting, and 7 berrylike aneurysms were treated. Seven aneurysms were adjunctively coiled. Eight of the 10 patients received a single-antiplatelet protocol of aspirin, 1 patient was treated with prasugrel only, and 1 patient was treated with tirofiban first and then switched to the aspirin single-antiplatelet protocol. One device-related complication occurred, a thrombosis of an overstented branch. All stents, however, remained open at DSA, CTA, or MRA follow-up. CONCLUSIONS:The implantation of flow diverters with reduced thrombogenicity due to hydrophilic surface coating under singleantiplatelet therapy seems to be an option in carefully selected cases of SAH due to aneurysm rupture.

Flow Diversion for Reconstruction of Intradural Vertebral Artery Dissecting Aneurysms Causing Subarachnoid Hemorrhage—A Retrospective Study From Four Neurovascular Centers

“…The remaining 22 patients either recovered completely (n = 18) or regained independence in their daily routine (GOS 4: n = 4). In summary, high Hunt and Hess grades and the necessity for adjunctive techniques in ruptured dissecting VA aneurysms and respective comorbidities were associated with poor outcomes in our patients, according to earlier studies (11,17,30).…”

“…However, several investigations suggested the feasibility and safety of this approach ( 25 , 29 ). Prior experience has shown that the hemorrhage-induced platelet activation requires a tailored dosage based on response tests (e.g., Multiplate, Roche Diagnostics; VerifyNow, Accriva), with prasugrel being more efficient than ASA ( 30 ).…”

First Experience of Three Neurovascular Centers With the p64MW-HPC, a Low-Profile Flow Diverter Designed for Proximal Cerebral Vessels With Antithrombotic Coating

“…The stent-carrier module of the p64MW features an independently movable wire that can be placed 6 cm distal to the stent in order to provide increased stability during placement and preserve distal access after deployment. The potentially most significant improvement is its availability with a hydrophilic polymer coating that inhibits platelet adhesion and activation, and thus allows early reduction of DAPT or even single anti-platelet therapy (SAPT) (17,(22)(23)(24)(25)(26).…”

“…Ex vivo testing has demonstrated that platelets in contact with HPC-covered FDS are significantly less activated than platelets in contact with uncoated FDS (16). Additionally, first clinical evidence indicates that applying the HPC technology to FDS allows reduction of DAPT in selected cases of unruptured and even ruptured cerebral aneurysms (17)(18)(19)(20). Whether the HPC technology may delay neo-endothelialization, and thus aneurysm occlusion, remains to be elucidated.…”

Treatment of Supraophthalmic Internal Carotid Artery Fenestration with an Associated Aneurysm via Flow Diversion: A Case Report

“…3 Sufficient occlusion rates were also achieved for ruptured aneurysms, 2 even considering new techniques to address the issue of antithrombotic therapy in acute subarachnoid hemorrhage. 14,15 Concerning altered cerebral perfusion after implantation of a flow diverting device, risk factors include smoking and aneurysm size, 11 but late ischemic events seem to be rare. 7 In our case, the transient hypoperfusion of the A1 segment of the treated side was compensated by crossflow from the right ICA and normalized within twelve-month post-implantation.…”