DOI: 10.1227/neu.0000000000004150 ISSN: 0148-396X

Safety and Efficacy of 3-Month Versus 6-Month Duration of Dual Antiplatelet Therapy in Pipeline Embolization Treatment of Intracranial Aneurysms

Joshua A. Cuoco, Nathan Ritchey, Mark Constable, Alan C. Wang, Jennifer E. Kim, Victoria Schunemann, Patrick P. Youssef, Ciaran J. Powers, Shahid M. Nimjee
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BACKGROUND AND OBJECTIVES:

Dual antiplatelet therapy (DAPT) is considered the standard medication regimen after Pipeline Embolization Device (PED) treatment of intracranial aneurysms. However, the optimal duration of DAPT after PED remains uncertain. We compared the safety and efficacy of 3 months vs 6 months or more of DAPT in the PED treatment of intracranial aneurysms.

METHODS:

We performed a retrospective cohort comparison study of 257 consecutive patients with intracranial aneurysms treated with PED who were either prescribed a 3-month (early termination) or ≥6-month course (standard duration) of DAPT. All patients had clinical follow-up of at least 3 months after discontinuation of DAPT. Baseline demographics, aneurysm characteristics, periprocedural data, complications before and after discontinuation of DAPT, and aneurysm occlusion rates on follow-up angiography were compared between cohorts.

RESULTS:

The study cohort consisted of 257 patients, including 155 patients in the early termination group and 102 patients in the standard duration group. Total complications after DAPT discontinuation were significantly lower in the early termination cohort (1.3% vs 9.8%, P = .002). There were no significant differences in total major complications between groups after DAPT cessation, nor were there differences in any specific major complication. Minor thromboembolic complications were significantly lower in the early termination cohort (1.3% vs 8.8%, P = .008) after DAPT discontinuation without a significant difference in any specific event. The rate of complete aneurysm occlusion on 6-month follow-up angiography was significantly higher in the early termination cohort (82.6% vs 70.6%, P = .024).

CONCLUSION:

In this study, we found that early termination of DAPT at 3 months after PED treatment has overall similar safety and efficacy outcomes as compared with the current standard 6-month regimen. These preliminary data encourage prospective studies to determine optimal DAPT durations in the PED treatment of intracranial aneurysms.

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