Introduction Flow diversion has well established for the treatment of cerebral aneurysms, however, the need for dual antiplatelet therapy is a significantly limiting factor.

Reduction of the essential antiplatelet regimen may enable flow diversion for currently ineligible patient groups e.g. in the acute setting and/or under multimedication and might further reduce the risk of treatment-related adverse events.

Aim of Study The aim of the study was to observe the angiographic and clinical outcome of the endovascular treatment with the novel Derivo with Heal technology under prasugrel monotherapy.

Methods Between December 2022 and December 2023 patients were prospectively included. Demographic data, procedural details, antiplatelet regimen and adverse events were recorded.

Results 33 lesions were successfully treated with the D2heal under prasugrel monotherapy.

Directly treatment-related adverse events were observed in five patients. Four were resulting from insufficiency of the femoral closure device and were resolved by stenting. In another, treatment of a giant inflammatory ICA aneurysm causing progredient vision loss was performed uneventfully. The patient presented hemiparesis and aphasia due to SAH postinterventionally. The neurologic deficits were completely regredient until discharge.

Immediately after the implantation, a high percentage (44%) of the lesions remained unaltered in flow. At the first angiographic follow up proposed 3 months after the intervention 53% of the lesions were completely occluded; 43% showed diminished flow. Only 4% (n=1) showed no changes in perfusion.

Conclusion The D2heal under prasugrel monotherapy is safe and efficient. No increase in risk of ischaemia was observed. However, multicentric studies are warranted.