Early Termination versus Standard Regimen Duration of Dual Antiplatelet Therapy in Intracranial Aneurysm Patients Treated with Pipeline Embolization Device Flex with Shield Technology: Preliminary Experience of 3 United States Centers

Jaims Lim, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Andre Monteiro, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Gustavo M. Cortez, Baptist Health Downtown and Lyerly Neurosurgery, Jacksonville, Florida, USA.
Victor H. Benalia, Baptist Health Downtown and Lyerly Neurosurgery, Jacksonville, Florida, USA.
Ammad A. Baig, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Wady T. Jacoby, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Brianna M. Donnelly, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Bennett R. Levy, George Washington University School of Medicine, Washington, DC 20052.
Vinay Jaikumar, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Jason M. Davies, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Department of Bioinformatics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Kenneth V. Snyder, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Adnan H. Siddiqui, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Ricardo A. Hanel, Baptist Health Downtown and Lyerly Neurosurgery, Jacksonville, Florida, USA.
Elad I. Levy, Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA; Department of Neurosurgery, Gates Vascular Institute at Kaleida Health, Buffalo, New York, USA; Canon Stroke and Vascular Research Center, University at Buffalo, Buffalo, New York, USA; Jacobs Institute, Buffalo, New York, USA; Department of Radiology, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.
Kunal Vakharia, Department of Neurosurgery, University of South Florida, Tampa, Florida, USA. Electronic address: kvakharia@usf.edu.

Document Type

Journal Article

Publication Date

7-26-2023

Journal

World neurosurgery

DOI

10.1016/j.wneu.2023.07.101

Keywords

Aneurysm; PED; PED-Shield; aneurysm treatment; flow diversion; intracranial aneurysm; pipeline flow diversion

Abstract

BACKGROUND: Pipeline Flex Embolization Device with Shield Technology (PED-Shield) is a third-generation flow diverter with reduced thromboembolic potential. However, safety profile and Dual AntiPlatelet Therapy (DAPT) recommendations with PED-Shield is not well-established. We aim to assess the safety and complication profile with early termination of DAPT with use of PED-Shield. METHODS: Databases of 3 high-volume cerebrovascular centers were retrospectively reviewed. We identified patients with unruptured and ruptured intracranial aneurysms treated with PED-Shield. Patient demographics, aneurysm characteristics, complications and angiographic outcomes were extracted. All patients that had both early termination of DAPT, defined as <180-days, as well as standard duration were included. RESULTS: 37 patients, totaling 37 aneurysms, had early termination of DAPT while 24 patients with 24 aneurysms received standard duration (>180-days) of DAPT. There was no difference in pre-procedural DAPT regimens between the groups (P=0.503).Following DAPT termination, one major thromboembolic complication was observed in the early termination group while no major or minor thromboembolic or hemorrhagic complication was noted in the standard duration group. Time of angiographic follow-up was not statistically different (P=0.063) between the early termination (343 days, IQR 114-371) and the standard duration (175 days, IQR 111-224.5) groups. There were no statistically significant differences in complete aneurysm occlusion (p=0.857), residual neck (p=0.582) and aneurysm remnant (p=0.352) rates between the groups on angiography. CONCLUSIONS: Early termination of DAPT proves safe after PED-Shield treatment of intracranial aneurysms with comparable complete occlusion rates.

Department

School of Medicine and Health Sciences Student Works

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