Introduction Flow diversion has emerged as a promising treatment strategy for intracranial aneurysms, yet the influence of antiplatelet therapy on treatment outcomes remains uncertain. Variability in antiplatelet regimen usage further complicates treatment standardization.

Aim of Study This survey aimed to investigate common practices of antiplatelet medication usage in flow diversion for intracranial aneurysms worldwide.

Methods An anonymous online survey explored antiplatelet therapy aspects in neurointerventions, including agent selection, dosing, and duration. The survey was distributed through international neurointerventional societies, including ESMINT, and mailing lists.

Results 442 respondents from 53 countries participated, revealing heterogeneity in antiplatelet protocols. DAPT, primarily combining low-dose aspirin with clopidogrel (68%), was the most common approach. However, alternative P2Y12 inhibitors are increasingly being used with the main reasons for preferring ticagrelor (21%) over prasugrel (10%) being availability and bleeding risk, while the main reason for using prasugrel over ticagrelor is patient compliance. Resistance testing for antiplatelet agents was conducted by 62% of responders, with the VerifyNow system being the most popular method. Strategies to manage resistance included dose escalation (17%) and switching (83%) to alternative agents. Interest in participating in future trials investigating antiplatelet therapy duration and SAPT versus DAPT was high (77% and 58%, respectively).

Conclusion Antiplatelet therapy practices following flow diversion procedures vary globally, with a growing interest in alternative agents and a willingness to participate in future trials. Standardization efforts and further investigation are crucial for optimizing neurointerventional outcomes.

Disclosure of Interest no.