Rajsrinivas Parthasarathy1, Vipul Gupta1, Aditya Gupta2. 1. 1 Department of Neurointerventional Surgery, Artemis Agrim Institute of Neuroscience , Haryana , India. 2. 2 Department of Neurosurgery, Artemis Agrim Institute of Neuroscience , Haryana , India.
Abstract
OBJECTIVE: Blister like aneurysm (BLA) is extremely challenging to treat; endoluminal reconstruction has emerged as the most promising treatment method. When to treat after the ictus, the timing of administration of antiplatelet and causal relationship between platelet function testing results and thrombo-embolism is unclear. We theorized that Prasugrel with a lower incidence of resistance may be a safe suitable alternative to clopidogrel in patients treated with a flow diverter (FD). METHODS: Prospectively collected data from consecutive patients treated for a ruptured blister with an FD was reviewed. Device deployment was timed to be at 2 h following Prasugrel loading. Thrombo-embolic and hemorrhagic complications, and occlusion rates were documented. RESULTS: Nine patients were included. Most were females (55%); the median age was 55 (43, 65). The median Fischer grade was 3 (2, 4). A single pipeline device was deployed in all within 24 h of admission; the median time from ictus to device deployment was 4 days (2, 30). There were no thrombo-embolic or hemorrhagic complication. Complete occlusion was noted in 89% (n = 9). CONCLUSION: Prasugrel loading timed 2 h prior to stent delivery did not increase thrombo-embolic or hemorrhagic complications. Single stent that is well apposed against the wall appears to be an effective treatment strategy to treat BLA. Advances in knowledge: Treatment of acutely ruptured BLA with a single pipeline device deployed at 2 h after Prasugrel loading appears to be safe.
OBJECTIVE: Blister like aneurysm (BLA) is extremely challenging to treat; endoluminal reconstruction has emerged as the most promising treatment method. When to treat after the ictus, the timing of administration of antiplatelet and causal relationship between platelet function testing results and thrombo-embolism is unclear. We theorized that Prasugrel with a lower incidence of resistance may be a safe suitable alternative to clopidogrel in patients treated with a flow diverter (FD). METHODS: Prospectively collected data from consecutive patients treated for a ruptured blister with an FD was reviewed. Device deployment was timed to be at 2 h following Prasugrel loading. Thrombo-embolic and hemorrhagic complications, and occlusion rates were documented. RESULTS: Nine patients were included. Most were females (55%); the median age was 55 (43, 65). The median Fischer grade was 3 (2, 4). A single pipeline device was deployed in all within 24 h of admission; the median time from ictus to device deployment was 4 days (2, 30). There were no thrombo-embolic or hemorrhagic complication. Complete occlusion was noted in 89% (n = 9). CONCLUSION:Prasugrel loading timed 2 h prior to stent delivery did not increase thrombo-embolic or hemorrhagic complications. Single stent that is well apposed against the wall appears to be an effective treatment strategy to treat BLA. Advances in knowledge: Treatment of acutely ruptured BLA with a single pipeline device deployed at 2 h after Prasugrel loading appears to be safe.
Authors: Raghav Gupta; Justin M Moore; Christoph J Griessenauer; Nimer Adeeb; Apar S Patel; Roy Youn; Karen Poliskey; Ajith J Thomas; Christopher S Ogilvy Journal: World Neurosurg Date: 2016-09-15 Impact factor: 2.104
Authors: Byung-Hee Lee; Byung Moon Kim; Moon Sun Park; Sung Il Park; Eun Chul Chung; Sang Hyun Suh; Chun Sik Choi; Yu Sam Won; In Kyu Yu Journal: J Neurosurg Date: 2009-03 Impact factor: 5.115
Authors: Ana Marcos Gonzalez; Ana Paula Narata; Hasan Yilmaz; Philippe Bijlenga; Ivan Radovanovic; Karl Schaller; Karl-Olof Lovblad; Vitor Mendes Pereira Journal: Eur J Radiol Date: 2013-10-06 Impact factor: 3.528
Authors: S Hassan Akbari; Matthew R Reynolds; Yasha Kadkhodayan; Dewitte T Cross; Christopher J Moran Journal: J Neurointerv Surg Date: 2012-05-03 Impact factor: 5.836
Authors: A Scerrati; J Visani; M E Flacco; L Ricciardi; S Trungu; A Raco; F Dones; P De Bonis; C L Sturiale Journal: AJNR Am J Neuroradiol Date: 2020-12-24 Impact factor: 3.825
Authors: Michelle F M Ten Brinck; Viktoria E Shimanskaya; René Aquarius; Ronald H M A Bartels; Frederick J A Meijer; Petra C Koopmans; Guido de Jong; Ajay K Wakhloo; Joost de Vries; Hieronymus D Boogaarts Journal: Brain Sci Date: 2022-03-15