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CASE REPORT
Use of aspirin as sole oral antiplatelet therapy in acute flow diversion for ruptured dissecting aneurysms
  1. Albert Ho Yuen Chiu1,2,
  2. Rajalakshmi Ramesh3,
  3. Jason Wenderoth1,2,
  4. Mark Davies4,5,
  5. Andrew Cheung1
  1. 1Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
  2. 2Prince of Wales Clinical School, University of New South Wales, Randwick, Australia
  3. 3Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia
  4. 4Department of Neurosurgery, St George Hospital, Kogarah, New South Wales, Australia
  5. 5St George and Sutherland Clinical School, University of New South Wales, Kogarah, Australia
  1. Correspondence to Dr A H Y Chiu, Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital and Community Health Services, Barker St, Randwick, NSW 2031, Australia; albert.h.chiu{at}gmail.com

Abstract

Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern.

We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab. To our knowledge, this is the first case of an acute flow diversion performed using only aspirin as the sole oral antiplatelet agent.

  • Aneurysm
  • Flow Diverter
  • Platelets
  • Hemorrhage

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