scholarly journals Antiplatelet Therapy for Prevention of Thromboembolic Complications Associated with Coil Embolization of Unruptured Cerebral Aneurysms

Drugs in R&D ◽  
2012 ◽  
Vol 12 (1) ◽  
pp. 1-7 ◽  
Author(s):  
Yasushi Matsumoto ◽  
Ryushi Kondo ◽  
Yasuhiko Matsumori ◽  
Hiroaki Shimizu ◽  
Akira Takahashi ◽  
...  
2007 ◽  
Vol 28 (9) ◽  
pp. 1778-1782 ◽  
Author(s):  
N.K. Yamada ◽  
D.T. Cross ◽  
T.K. Pilgram ◽  
C.J. Moran ◽  
C.P. Derdeyn ◽  
...  

2021 ◽  
pp. neurintsurg-2020-016994
Author(s):  
Saeko Higashiguchi ◽  
Akiyo Sadato ◽  
Ichiro Nakahara ◽  
Shoji Matsumoto ◽  
Motoharu Hayakawa ◽  
...  

BackgroundThromboembolic complications (TECs) are frequent during the endovascular treatment of unruptured aneurysms. To prevent TECs, dual antiplatelet therapy using aspirin and clopidogrel is recommended for the perioperative period. In patients with a poor response, clopidogrel is a risk factor for TECs. To prevent TECs, our study assessed the stratified use of prasugrel.MethodsPatients who underwent endovascular therapy for unruptured cerebral aneurysms from April 2017 to August 2019 were enrolled in this clinical study and given premedication with aspirin and clopidogrel for 2 weeks prior to the procedure. P2Y12 reaction units (PRU) were measured using the VerifyNow assay on the day before the procedure (tailored group). In subgroups with PRU <240, the clopidogrel dose was maintained (CPG subgroup). In subgroups with PRU ≥240, clopidogrel was changed to prasugrel (PSG subgroup). We compared the occurrence of TECs with retrospective consecutive cases from January 2015 to March 2017 without PRU assessments (non-tailored group). The frequency of TECs within 30 days was assessed as the primary endpoint.ResultsThe tailored and non-tailored groups comprised 167 and 50 patients, respectively. TECs occurred in 11 (6.6%) and 8 (16%) patients in the tailored and non-tailored groups (P=0.048), respectively. The HR for TECs was significantly reduced in the tailored group (HR 0.3, 95% CI 0.11 to 0.81); P=0.017) compared with the non-tailored group.ConclusionThe results suggest that tailored dual antiplatelet therapy medication with PRU significantly reduces the frequency of TECs without increasing hemorrhagic complications.


2013 ◽  
Vol 155 (8) ◽  
pp. 1549-1557 ◽  
Author(s):  
Kenichi Kono ◽  
Aki Shintani ◽  
Ryo Yoshimura ◽  
Hideo Okada ◽  
Yuko Tanaka ◽  
...  

1999 ◽  
Vol 5 (1_suppl) ◽  
pp. 89-92 ◽  
Author(s):  
Y. Kaku ◽  
S. Yoshimura ◽  
K. Hayashi ◽  
T. Ueda ◽  
N. Sakai

We describe follow-up clinical and angiographical results in patients with unruptured cerebral aneurysms treated with IDC or GDC. In 28 patients who underwent intra-aneurysmal occlusion for unruptured aneurysms, there were no permanent neurological deficits in the periprocedural period, while three transient neurological deficits were observed. On the angiograms obtained immediately after the procedure, complete aneurysmal occlusion was achieved in three patients (10.7%), a small neck remnant was detected in two cases (7.1%), a body filling in 12 cases (42.9%) and both of them were detected in 11 patients (39.3%). On the follow up angiograms (median angiographical follow-up period 15.6 months), 46.4% of incompletely obliterated aneurysms showed aneurysmal recanalization, and a incompletely embolized aneurysm ruptured 15 months after initial embolization. Detachable platinum coil embolization is a safe treatment for unruptured aneurysms with a lower incidence of peri-procedural morbidity, wheareas follow-up results are less satisfactory in cases involving incompletely obliterated lesions. With this limitation in mind, patients need to be very carefully chosen for GDC embolization and strict follow-up angiography is mandatory when a complete embolization is not achieved.


2017 ◽  
Vol 11 (5) ◽  
pp. 235-239
Author(s):  
Yu Okuma ◽  
Kenji Sugiu ◽  
Nobuyuki Hirotsune ◽  
Tomohito Hishikawa ◽  
Kenichiro Muraoka ◽  
...  

2009 ◽  
Vol 151 (12) ◽  
pp. 1663-1672 ◽  
Author(s):  
Andrew Lozen ◽  
Sunil Manjila ◽  
Richard Rhiew ◽  
Richard Fessler

2018 ◽  
Vol 12 (4) ◽  
pp. 169-174
Author(s):  
Shingo Nishihiro ◽  
Kenji Sugiu ◽  
Tomohito Hishikawa ◽  
Masafumi Hiramatsu ◽  
Naoya Kidani ◽  
...  

2018 ◽  
Vol 10 (Suppl 1) ◽  
pp. i9-i18 ◽  
Author(s):  
D Fiorella ◽  
P Lylyk ◽  
I Szikora ◽  
M E Kelly ◽  
F C Albuquerque ◽  
...  

Endovascular, endosaccular, coil embolization has emerged as an established therapy for both ruptured and unruptured cerebral aneurysms. However, many aneurysms are not cured using conventional endovascular techniques. Coil embolization often results in incomplete aneurysm occlusion or recanalization in the ensuing months after treatment. The Pipeline embolization device (PED; Chestnut Medical) represents a new generation endoluminal implant which is designed to treat aneurysms by reconstructing the diseased parent artery. Immediately after implantation, the PED functions to divert flow from the aneurysm, creating an environment conducive to thrombosis. With time, the PED is incorporated into the vessel wall as neointimal–endothelial overgrowth occurs along the construct. Ultimately, this process results in the durable complete exclusion of the aneurysm from the cerebrovasculature and a definitive endoluminal reconstruction of the diseased parent artery.


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