Stent-assisted coiling and flow diversion with hpc-coated devices under prasugrel monotherapy in ruptured wide-neck aneurysms: a multicenter case series.

Abstract

Purpose: To evaluate the safety, efficacy, and clinical outcomes of stent-assisted coiling (SAC) and flow diversion (FD) with hydrophilic polymer-coated (HPC) devices under prasugrel single antiplatelet therapy (SAPT) in the treatment of acutely ruptured wide-neck intracranial aneurysms.

Methods: This multicenter retrospective case series included patients with ruptured saccular intracranial aneurysms treated through SAC or FD with HPC-coated devices under SAPT at four specialized neurovascular centers. Baseline demographics, aneurysm characteristics, procedural details, and clinical outcomes were analyzed. The primary outcomes included technical success, periprocedural complications, aneurysm occlusion rates at follow-up (FU), and functional outcomes assessed with the modified Rankin Scale (mRS).

Results: A total of 46 patients were included (mean age 57.4 years). SAC and FD were performed in equal proportions. Technical success was achieved in 100% of cases. The immediate complete occlusion rate was significantly higher for SAC (95.7%) than FD (21.7%, p < 0.001). However, the occlusion rates at 12-month FU were comparable (SAC 100% vs. FD 95%, p = 0.364). The overall periprocedural complication rate was low (4.3%), and mortality before discharge was 10.9%. Favorable functional outcomes (mRS ≤ 2) at the last FU were achieved in 84% of patients, and no significant differences were observed between the SAC and FD groups.

Conclusion: SAC and FD with HPC-coated devices under prasugrel SAPT appeared to be safe and effective in treating ruptured wide-neck aneurysms. Whereas SAC achieved higher immediate occlusion rates, the long-term outcomes were comparable between groups. These findings support the feasibility of SAPT in this high-risk population and warrant further prospective validation.