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Safety and efficacy of ticagrelor as single antiplatelet therapy in prevention of thromboembolic complications associated with the Pipeline Embolization Device (PED): multicenter experience
  1. Mahmoud H Mohammaden1,2,
  2. Stephen W English2,
  3. Christopher J Stapleton3,
  4. Eman Khedr4,
  5. Ahmed Shoyb5,
  6. Ahmed Hegazy6,
  7. Ahmed Elbassiouny7
  1. 1 Department of Neurology, Faculty of Medicine, South Valley University, Qena, Egypt
  2. 2 Department of Neurology, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Emory University School of Medicine, Atlanta, Georgia, USA
  3. 3 Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
  4. 4 Department of Neurology, Assiut University Faculty of Medicine, Assiut, Egypt
  5. 5 Department of Neurology, Faculty of Medicine, Aswan University, Sahary City, Egypt
  6. 6 Department of Neurosurgery, Cairo University Kasr Alainy Faculty of Medicine, Cairo, Egypt
  7. 7 Department of Neurology, Ain Shams University Faculty of Medicine, Cairo, Egypt
  1. Correspondence to Professor Ahmed Elbassiouny, Department of Neurology, Ain Shams University Faculty of Medicine, Cairo 11566, Egypt; ahmedelbassiony{at}


Background Flow diversion (FD) is a common treatment modality for complex intracranial aneurysms. A major concern regarding the use of FD is thromboembolic events (TEE). There is debate surrounding the optimal antiplatelet regimen to prevent TEE. We aim to evaluate the safety and efficacy of ticagrelor as a single antiplatelet therapy (SAPT) for the prevention of TEE following FD for complex aneurysm treatment.

Methods A retrospective review of a prospectively maintained neuroendovascular database at three endovascular centers was performed. Patients were included if they had an intracranial aneurysm that was treated with FD between January 2018 and September 2019 and were treated with ticagrelor as SAPT. Primary outcomes included early (within 72 hours post-procedure) and late (within 6 months) ischemic events.

Results A total of 24 patients (mean age 47.7 years) with 36 aneurysms were eligible for analysis, including 15 (62.5%) females. 14 (58.3%) patients presented with subarachnoid hemorrhage. 35 aneurysms arose from the anterior circulation and 1 from the posterior circulation. 23 aneurysms had a saccular morphology, whereas 7 were fusiform and 6 were blister. For the treatment of all 36 aneurysms, 30 procedures were performed with 32 FD devices. Procedural in-stent thrombosis occurred in 2 cases and was treated with intra-arterial tirofiban without complications. Aneurysm re-bleeding was reported in 1 (4.2%) patient. There were no reported early or late TEE. Three patients discontinued ticagrelor due to systemic side effects.

Conclusion Ticagrelor is a safe and effective SAPT for the prevention of TEE after FD. Large multicenter prospective studies are warranted to validate our findings.

  • flow diverter
  • device
  • hemorrhage
  • drug
  • platelets

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  • Contributors MHM: design of the work, acquisition of data, interpretation of data, drafting of the manuscript. SWE, CJS, EK, AS, AH: critical revision of the manuscript. AE: study conception, design of the work, acquisition of data, interpretation of data, drafting of the manuscript. All authors gave final approval of the version to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

  • 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 for publication Not required.

  • Ethics approval IRB obtained through Aswan University, ASU44116.

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

  • Data availability statement Data are available upon reasonable request. The unpublished data from this dataset is held by MHM/AE. Requests for data sharing would be required to be discussed with them directly.