2023 American Academy of Neurology Abstract Website

Objective:

Objective is to evaluate if loading doses of aspirin and clopidogrel (LDAC) reduces TEE without increased intracranial hemorrhage (IH) and improves outcomes in SARIA.

Background:

There are no universal antiplatelets regimens to prevent Thromboemboembolic event (TEE) in stent-assisted repair of intracranial aneurysms (SARIA). Antiplatelets effects are highest in first 4 hours.

Design/Methods:

Consecutive patients underwent SARIA with LDAC; aspirin 324 mg (4 baby aspirin) and clopidogrel 300 mg in 2 to 4 hours before procedure were enrolled from 2011 to 2022. Outcome was measured using modified Rankin Scale (mRS) score.

Results:

112 patients with mean age of 53 ± 13 underwent SARIA (7 ruptured and 55 symptomatic). Aneurysms are; Right internal carotid artery (ICA) 27, left ICA 35, middle cerebral artery 25, basilar artery 19 and anterior communicating artery 6. There are no intra-operative ruptures. Small left subarachnoid hemorrhage developed on a right MCA aneurysm on day 3, which resolved spontaneously. Stent thrombosis in one; resolved with intraarterial integrilin with no stroke. Clinical TEE were observed in 2 cases (1.8%); first event was in a 42 years old woman with a giant right ICA giant aneurysm and achieved mRS 1. Second event was visual distortion and diplopia in a 66 years old woman with basilar artery aneurysm and achieved mRS1. Ruptured and symptomatic were repaired and no subarachnoid hemorrhages during follow-up. Immediate complete and near complete obliteration of aneurysm was observed in 72% and subtotal in 28%. There was no mortality or permanent disability in our series. 90 days mRankins 0 and 1 was observed in 98 (92.5%), mRS 2 in 7(6.6%) at baseline and mRS 3 in 2 (1.9%), which sustained in 12 months.

Conclusions:

LDAC in SARIA is associated with reduced TEE without increased IH and good outcome. LDAP may be an option in SARIA to prevent TEE. Further studies are required.