Table 1

Recent literature presenting results from neuroendovascular management of acutely ruptured intracerebral aneurysms.

Study	Study design	Complications	EVD, antiplatelet strategies
Tahiten et al, 20095	Case series 2 centers 61 patients	TC, 11% TC treated with abciximab infusion HC, 7% Rebleeding, 2%	Variable intraprocedural heparin regimens DAPT started after stenting No evaluation of antiplatelet effects EVD policy not described
Bodily et al, 20114	Systematic review 17 case series 339 patients	Symptomatic TC, 6% Symptomatic HC, 8% (mainly re-ruptures, EVD related)	Variable intraprocedural heparin regimens DAPT started after stenting No evaluation of antiplatelet effects Variable EVD policy
Lessne et al, 20119	Case series 1 center 30 patients	20% stroke rate	Intraprocedural heparin bolus Target ACT 250–300 s No standardized antiplatelet protocol, DAPT during or after intervention No evaluation of antiplatelet effects EVD policy not described
Amenta et al, 20126	Case series 1 center 65 patients	Intraoperative stent thrombosis, 7.7% HC, 7.7%	600 mg loading dose clopidogrel after stent implant No evaluation of antiplatelet effects Heparin bolus (50–150 U/kg) after first coil implant Target ACT 300–400 s EVD placed before intervention in 70% If antiplatelet reversal required, 10 units platelets before and 10 units during EVD placement
Chalouhi et al, 20133	Case series 1 center 47 patients	Overall complication rate, 25% Permanent morbidity, mortality, 12.7%	Intraprocedural loading dose clopidogrel (600 mg) No evaluation of antiplatelet effects Reduced heparin bolus (50 U/kg) after first coil implant EVD policy not described
Chung et al, 20148	Case series multicenter 72 patients	Periprocedural complications, 19.4% Asymptomatic TC, 5.6% Symptomatic TC, 6.9% HC, 6.9%	No heparin bolus DAPT started immediately before stenting, bolus via NGT No evaluation antiplatelet effects
Rouchaud et al, 201519	Systematic review 31 case series 240 patients	Perioperative stroke, 5% Perioperative ICH, 6.5% Early rebleeding, 8%	Variable/not addressed
Bechan et al, 201620	Case series multicenter 45 patients	TC, 20% (8.5% asymptomatic, 8.5% symptomatic, 3% fatal) HC, 11%	No heparin bolus Aspirin IV before stent implant Clopidogrel 300 mg bolus after the procedure No evaluation antiplatelet effects EVD before the intervention in 16%, after in 7%
Cai et al, 20 177	Case series 1 center 93 patients	Symptomatic TC, 11.8% HC, 10.8%	DAPT started after stenting No evaluation of antiplatelet effects EVD placed after discontinuation of clopidogrel, dual platelets; restarted day 7 after EVD
Ryan et al, 201721	Case series 1 center 13 patients	Intraprocedureal complications, 7.7%, vegetative state Periprocedural hemorrhage, 15.4%, both fatal	Proloading 650 mg aspirin, 650 mg clopidogrel, 6 hours before procedure Monitored antiplatelet effect EVD policy not detailed
Current study	Case series 1 center 47 patients	Asymptomatic TC, 8.5% HC, 0 Mortality, 4%	Preprocedure heparin bolus (IV, 70 U/kg) Target ACT, 2×normal Preprocedure DAPT orally or via NGT Neurostent implant: target P2Y12 receptor inhibition 60–240 PRU Flow diverter stent implant: target P2Y12 receptor inhibition 60–207 PRU Preprocedure EVD in 74% Postprocedure EVD in 6%, discontinuation of clopidogrel 72 hours

ACT, activated clotting time; DAPT, dual antiplatelet therapy; EVD, extraventricular drain; HC, hemorrhagic complications; ICH, intracerebral hemorrhage; NGT, nasogastric tube; PRU, P2Y12 reaction units; TC, thromboembolic complications.