Dual antiplatelet therapy practices following Pipeline Shield embolization and their impact on adverse events in three large real-life registries

Background

Dual Antiplatelet Therapy (DAPT) prescription following flow-diverter stent treatment of intracranial aneurysms is standard of care but evidence regarding the drugs of choice and duration of DAPT remains limited. We aim report to report practitioners’ DAPT prescribing habits and to analysis their impact on adverse events in real-world use of Pipeline™ Flex with Shield Technology stent.

Methods

Data from 3 post-market core lab adjudicated studies were retrospectively analyzed. Patients with acutely ruptured aneurysms, or on single APT were excluded. DAPT durations were collected, and patients were divided in 2 DAPT duration groups (< or ≥ 6 months).

Results

The analysis included 707 patients with 776 aneurysms. The P2Y12 inhibitor of choice was mainly clopidogrel in 68.7 %, ticagrelor in 15.8 % and prasugrel in 12.2 %. Median DAPT duration was 177 days (IQR 93–227). Younger patients and those with mRS ≤ 2 significantly received longer DAPT. Global ischemic stroke rate was 3.2 % (2.5 % before and 0.7 % after DAPT discontinuation) whereas major bleeding risk was 3.5 % (3.5 % before and 0 % after DAPT discontinuation). Post-discharge ischemic stroke and major bleeding rates were 1.8 % and 1.4 % respectively. Cumulative rates of both thromboembolic complications and ischemic strokes were higher in the < 6 months group (7.5 %) vs < 6 months group (4.6 %) without reaching statistical significance.

Conclusion

In this large real-world retrospective analysis, most major adverse events were reported within 30 days post-FDS procedure. Complications rates after discharge and after DAPT discontinuation were very low and similar between DAPT duration groups. These data provide a foundation for designing future prospective studies to evaluate optimal DAPT protocols—both in terms of drug type and duration—which could potentially inform future clinical guidelines.