Introduction A single antiplatelet therapy (SAPT) might be advantageous in determined clinical scenarios after flow diverter treatment of cerebral aneurysms.

Aim of Study To evaluate the efficacy and safety of prasugrel SAPT versus aspirin and clopidogrel dual antiplatelet therapy (DAPT).

Methods We performed a post hoc analysis of 4 retrospective multicenter studies including ruptured and unruptured aneurysms treated with flow diversion using either prasugrel SAPT or DAPT. Primary end points were the occurrence of thromboembolic complications (TEC) and complete aneurysm occlusion at the latest radiologic follow-up (mean, 18 months). Dichotomized comparisons of outcomes were performed between SAPT and DAPT. Additionally, the influence of various patient- and aneurysm-related variables on the occurrence of TEC was investigated using multivariable backward logistic regression.

Results 222 patients with 251 aneurysms were included, 90 (40.5%) in the SAPT and 132 (59.5%) in the DAPT group. TEC occurred in 6 patients (6.6%) of the SAPT and in 12 patients (9.0%) of the DAPT group (P = .62; OR, 0.712; 95% CI, 0.260-1.930). The primary treatment efficacy end point was reached in 82 patients (80.4%) of the SAPT and in 115 patients (78.2%) of the DAPT group (P = .752; OR, 1.141; 95% CI, 0.599-2.101). Logistic regression showed that non-surface-modified flow diverters (P = .014) and fusiform aneurysm morphology (P = .004) significantly increased the probability of TEC.

Conclusion Prasugrel SAPT after flow diverter treatment may be as safe and effective as DAPT and could, therefore, be a valid alternative in selected patients.

Disclosure of Interest no.