Association of preprocedural antiplatelet use with decreased thromboembolic complications for intracranial aneurysms undergoing intrasaccular flow disruption
Diestro, Jose Danilo Bengzon Adeeb, Nimer Musmar, Basel Salim, Hamza Aslan, Assala Cancelliere, Nicole M McLellan, Rachel M Algin, Oktay Ghozy, Sherief Lay, Sovann V
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Authors
Adeeb, Nimer
Musmar, Basel
Salim, Hamza
Aslan, Assala
Cancelliere, Nicole M
McLellan, Rachel M
Algin, Oktay
Ghozy, Sherief
Lay, Sovann V
Guenego, Adrien
Renieri, Leonardo
Carnevale, Joseph
Saliou, Guillaume
Mastorakos, Panagiotis
El Naamani, Kareem
Shotar, Eimad
Premat, Kevin
Möhlenbruch, Markus
Kral, Michael
Bernstock, Joshua D
Doron, Omer
Chung, Charlotte
Salem, Mohamed M
Lylyk, Ivan
Foreman, Paul M
Vachhani, Jay A
Shaikh, Hamza
Župančić, Vedran
Hafeez, Muhammad U
Catapano, Joshua
Waqas, Muhammad
Ibrahim, Mohamed K
Mohammed, Marwa A
Imamoglu, Cetin
Bayrak, Ahmet
Rabinov, James D
Ren, Yifan
Schirmer, Clemens M
Piano, Mariangela
Kühn, Anna L
Michelozzi, Caterina
Elens, Stéphanie
Starke, Robert M
Hassan, Ameer E
Ogilvie, Mark
Nguyen, Anh
Jones, Jesse
Brinjikji, Waleed
Nawka, Marie T
Psychogios, Marios
Ulfert, Christian
Pukenas, Bryan
Burkhardt, Jan-Karl
Huynh, Thien
Martinez-Gutierrez, Juan Carlos
Essibayi, Muhammed Amir
Sheth, Sunil A
Spiegel, Gary
Tawk, Rabih G
Lubicz, Boris
Panni, Pietro
Puri, Ajit S
Pero, Guglielmo
Nossek, Erez
Raz, Eytan
Killer-Oberpfalzer, Monika
Griessenauer, Christoph J
Asadi, Hamed
Siddiqui, Adnan
Brook, Allan L
Altschul, David
Spears, Julian
Marotta, Thomas R
Ducruet, Andrew F
Albuquerque, Felipe C
Regenhardt, Robert W
Stapleton, Christopher J
Kan, Peter
Kalousek, Vladimir
Lylyk, Pedro
Boddu, Srikanth
Knopman, Jared
Aziz-Sultan, Mohammad A
Tjoumakaris, Stavropoula I
Jabbour, Pascal M
Clarençon, Frédéric
Limbucci, Nicola
Cuellar-Saenz, Hugo H
Mendes Pereira, Vitor
Patel, Aman B
Dmytriw, Adam A
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UMass Chan Affiliations
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Abstract
Objective: This study was conducted to investigate the impact of antiplatelet administration in the periprocedural period on the occurrence of thromboembolic complications (TECs) in patients undergoing treatment using the Woven EndoBridge (WEB) device for intracranial wide-necked bifurcation aneurysms. The primary objective was to assess whether the use of antiplatelets in the pre- and postprocedural phases reduces the likelihood of developing TECs, considering various covariates.
Methods: A retrospective multicenter observational study was conducted within the WorldWideWEB Consortium and comprised 38 academic centers with endovascular treatment capabilities. Univariable and multivariable logistic regression analyses were performed to determine the association between antiplatelet use and TECs, adjusting for covariates. Missing predictor data were addressed using multiple imputation.
Results: The study comprised two cohorts: one addressing general thromboembolic events and consisting of 1412 patients, among whom 103 experienced TECs, and another focusing on symptomatic thromboembolic events and comprising 1395 patients, of whom 50 experienced symptomatic TECs. Preprocedural antiplatelet use was associated with a reduced likelihood of overall TECs (OR 0.32, 95% CI 0.19-0.53, p < 0.001) and symptomatic TECs (OR 0.49, 95% CI 0.25-0.95, p = 0.036), whereas postprocedural antiplatelet use showed no significant association with TECs. The study also revealed additional predictors of TECs, including stent use (overall: OR 4.96, 95% CI 2.38-10.3, p < 0.001; symptomatic: OR 3.24, 95% CI 1.26-8.36, p = 0.015), WEB single-layer sphere (SLS) type (overall: OR 0.18, 95% CI 0.04-0.74, p = 0.017), and posterior circulation aneurysm location (symptomatic: OR 18.43, 95% CI 1.48-230, p = 0.024).
Conclusions: The findings of this study suggest that the preprocedural administration of antiplatelets is associated with a reduced likelihood of TECs in patients undergoing treatment with the WEB device for wide-necked bifurcation aneurysms. However, postprocedural antiplatelet use did not show a significant impact on TEC occurrence.
Source
Diestro JDB, Adeeb N, Musmar B, Salim H, Aslan A, Cancelliere NM, McLellan RM, Algin O, Ghozy S, Lay SV, Guenego A, Renieri L, Carnevale J, Saliou G, Mastorakos P, El Naamani K, Shotar E, Premat K, Möhlenbruch M, Kral M, Bernstock JD, Doron O, Chung C, Salem MM, Lylyk I, Foreman PM, Vachhani JA, Shaikh H, Župančić V, Hafeez MU, Catapano J, Waqas M, Ibrahim MK, Mohammed MA, Imamoglu C, Bayrak A, Rabinov JD, Ren Y, Schirmer CM, Piano M, Kühn AL, Michelozzi C, Elens S, Starke RM, Hassan AE, Ogilvie M, Nguyen A, Jones J, Brinjikji W, Nawka MT, Psychogios M, Ulfert C, Pukenas B, Burkhardt JK, Huynh T, Martinez-Gutierrez JC, Essibayi MA, Sheth SA, Spiegel G, Tawk RG, Lubicz B, Panni P, Puri AS, Pero G, Nossek E, Raz E, Killer-Oberpfalzer M, Griessenauer CJ, Asadi H, Siddiqui A, Brook AL, Altschul D, Spears J, Marotta TR, Ducruet AF, Albuquerque FC, Regenhardt RW, Stapleton CJ, Kan P, Kalousek V, Lylyk P, Boddu S, Knopman J, Aziz-Sultan MA, Tjoumakaris SI, Jabbour PM, Clarençon F, Limbucci N, Cuellar-Saenz HH, Mendes Pereira V, Patel AB, Dmytriw AA. Association of preprocedural antiplatelet use with decreased thromboembolic complications for intracranial aneurysms undergoing intrasaccular flow disruption. J Neurosurg. 2024 May 3:1-8. doi: 10.3171/2024.2.JNS232918. Epub ahead of print. PMID: 38701528.