Article Text

Download PDFPDF
Original research
Antiplatelet therapy and the risk of ischemic and hemorrhagic complications associated with Pipeline embolization of cerebral aneurysms: a systematic review and pooled analysis
  1. Hamidreza Saber1,
  2. Riyad Y Kherallah2,
  3. Mohamad O Hadied2,
  4. Shaghayegh Kazemlou3,
  5. Parthasarathi Chamiraju4,
  6. Sandra Narayanan1,4
  1. 1 Department of Neurology, Wayne State University School of Medicine, Detroit, Michigan, USA
  2. 2 Department of Medicine, Wayne State University School of Medicine, Detroit, Michigan, USA
  3. 3 Danaher Labs, San Jose, California, USA
  4. 4 Department of Neurosurgery, Wayne State University School of Medicine, Detroit, Michigan, USA
  1. Correspondence to Dr Hamidreza Saber, University Health Center, Detroit, MI 48201, USA; hsaber{at}


Background Pipeline embolization devices (PEDs) are increasingly used in the treatment of cerebral aneurysms. Yet, major ischemic or hemorrhagic complications after PED treatment associated with antiplatelet regimens are not well-established.

Objective To investigate the risk of ischemic and hemorrhagic complications associated with common antiplatelet regimens following PED treatment, and to examine whether platelet function testing (PFT) is associated with a lower risk of these complications.

Methods We searched Medline, Embase, and Cochrane from 2009 to 2017. Twenty-nine studies were included that had reported a uniform antiplatelet regimen protocol and had provided data on major ischemic and hemorrhagic complications following PED treatment. Random-effect meta-analysis was used to pool overall ischemic and hemorrhagic event rates across studies. The rate of these complications with respect to the antithrombotic regimen and PFT was assessed by χ2 proportional tests.

Results Overall, 2002 patients (age 55.9 years, 76% female) were included. A low-dose acetylsalicylic acid (ASA) regimen before and after PED treatment was associated with a higher rate of late ischemic complications than with high-dose ASA therapy (2.62 (95% CI 1.46 to 4.69) and 2.56 (1.41 to 4.64), respectively). Duration of post-procedure clopidogrel therapy <6 months was associated with greater rates of ischemic complications (1.56, 95% CI 1.11 to 2.20) than a clopidogrel regimen of ≥6 months. Performing PFT before PED treatment was not associated with the risk of ischemic complications (1.27, 95% CI 0.77 to 2.10).

Conclusion High-dose ASA therapy and clopidogrel treatment for at least 6 months were associated with a reduced incidence of ischemic events, without affecting the risk of hemorrhagic events.

  • aneurysm
  • stroke
  • flow diverter

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.


  • Contributors HS, RYK and SN participated in the conception and design of the study. HS, RYK and SK analyzed and interpreted the data. HS carried out the statistical analysis and wrote the article. SN, PC, MOH and HS revised the draft paper for intellectual content.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.