期刊
JOURNAL OF NEURORADIOLOGY
卷 46, 期 6, 页码 378-383出版社
MASSON EDITEUR
DOI: 10.1016/j.neurad.2019.01.094
关键词
Unruptured aneurysm; Flow diverter; Flow disrupter; Dual antiplatelet regimen; Clopidogrel; Ticagrelor
资金
- French Society for Childhood Cancer (SFCE)
- Federative Research Structure No.1 (SFR1)
- Hospital Clinical Research Program (PHRC) of France
- Vietnamese ministry of education and training
- MRI facility UMS IRMaGe of Grenoble
Purpose. - Standard dual antiplatelet therapy (DAPT) for complex aneurysms treated with flow diversion and flow disruption is acetylsalicylic acid (ASA) plus clopidogrel. However, clopidogrel resistance frequently occurs and can lead to thromboembolic events. Ticagrelor is an alternative not requiring platelet inhibition testing. We compared two DAFT regimens (ASA with clopidogrel or ticagrelor) on morbi-mortality, safety and efficacy of unruptured aneurysm embolization with flow diverter/disrupter. Materials and methods. - This retrospective analysis of a 1:1 matched cohort compares patients treated with ASA + clopidogrel (March 2013-December 2015) vs. ASA + ticagrelor (January 2016-March 2017). No platelet inhibition testing was conducted. Patients matched for age (+/- 10 years), type of treatment and aneurysm sac size (+/- 2 mm). Primary outcome measures were morbidity and mortality at 1-month; secondary outcomes were thromboembolic and hemorrhagic complications [on angiography and magnetic resonance imaging (MRI)] and groin complications. Outcomes were compared using bivariate analyses. Results. - Ninety patients fulfilled inclusion criteria, of which 80 remained after matching (40 per group). There was no statistical difference in 1-month morbidity between the ticagrelor and clopidogrel groups (2.5% vs. 10%, P=0.36) and no deaths reported. We observed no significant differences between ticagrelor and clopidogrel groups in terms of angiographic thromboembolic complications (5% vs. 12.5%, P=0.43), territorial infarction on DWI (2.5% vs. 7.5%, P=0.61), angiographic (0% vs. 0%, P=1) and MRI (5% vs 5%, P=1) hemorrhagic complications, new microbleeds (57.5% vs. 40%, P=0.12) and groin puncture complications (2.5% vs. 0%, P=1). At three months, there was no delayed territorial infarction or hemorrhage in either group. Conclusions. - Ticagrelor is safe and effective in replacing clopidogrel as DAPT for unruptured aneurysms. (C) 2019 Elsevier Masson SAS. All rights reserved.
作者
我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。
推荐
暂无数据