{
  "abstract": "Background Dual antiplatelet therapy (DAPT) is commonly used for flow diversion but may increase hemorrhagic complications. The surface-modified flow diverter (FD) p48 MW HPC may allow treatment with prasugrel-based single antiplatelet therapy (SAPT). Our study compared the safety and effectiveness of prasugrel-based SAPT vs DAPT in patients with unruptured saccular aneurysms arising from distal parent vessels treated with p48 MW HPC.Methods We conducted a multicenter, retrospective cohort study of adults with unruptured saccular aneurysms arising from distal parent vessels treated with the p48 MW HPC FD. The primary effectiveness outcome was complete aneurysm occlusion within 12 months. The primary safety outcome was MRI-detected silent ischemic lesions within 48 hours post-procedure, as well as periprocedural complications. Secondary outcomes included hemorrhagic complications, ischemic events, and all-cause mortality within 180 days after treatment.Results Overall, 101 patients were treated (mean age, 60.7 years; 69.3% women). SAPT and DAPT were used in 49 (48.5%) and 52 (51.5%) patients, respectively. Complete occlusion within 12 months was achieved in 79.6% (SAPT) vs 70.6% (DAPT) (P=0.36). Rates of ischemic and hemorrhagic events did not differ significantly (2.0% vs 7.7%, P=0.191; 0% vs 5.8%, P=0.088, respectively). In multivariable analysis, diabetes mellitus was an independent negative predictor of complete aneurysm occlusion (OR 0.26, 95% CI 0.07 to 0.96; P=0.043). Antiplatelet regimen (SAPT vs DAPT; OR 3.39, 95% CI 0.38 to 30.47; P=0.276), aneurysm neck size (P=0.104), aneurysm location (P=0.510), stent diameter (P=0.570), and proximal and distal parent-vessel diameters (P=0.398 and P=0.314, respectively) were not independently associated with complete occlusion.Conclusion In this multicenter retrospective cohort of distal small-vessel flow diversion with the p48 MW HPC, prasugrel-based SAPT was not associated with a significant increase in thromboembolic/ischemic events compared with DAPT; angiographic occlusion and hemorrhage signals were exploratory, with numerically fewer intracranial hemorrhages under SAPT without statistical significance.",
  "authors": [
    {
      "affiliations": [
        "Department of Neuroradiology, Philipps University of Marburg, Marburg, Hesse, Germany"
      ],
      "name": "Abdallah Aburub"
    },
    {
      "affiliations": [
        "Klinik für Neuroradiologie, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany"
      ],
      "name": "Hans Henkes"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Philipps University of Marburg, Marburg, Hesse, Germany",
        "Department of Interventional Radiology and Neuroradiology, Rhön Klinikum Campus Bad Neustadt, Bad Neustadt an der Saale, BY, Germany"
      ],
      "name": "André Kemmling"
    },
    {
      "affiliations": [
        "Institute of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, NRW, Germany"
      ],
      "name": "Michael Forsting"
    },
    {
      "affiliations": [
        "Radiology Department, UH St. Ivan Rilski, Sofia, Bulgaria"
      ],
      "name": "Alexander Sirakov"
    },
    {
      "affiliations": [
        "Central Institute for Diagnostic and Interventional Radiology Neuroradiology and Nuclear Medicine, Central Institute for Diagnostic and Interventional Radiology Neuroradiology and Nuclear Medicine, Offenbach am Main, Hessen, Germany"
      ],
      "name": "Zakarya Ali"
    },
    {
      "affiliations": [
        "Klinik für Neuroradiologie, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany"
      ],
      "name": "Philipp von Gottberg"
    },
    {
      "affiliations": [
        "Klinik für Neuroradiologie, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany"
      ],
      "name": "Kamran Hajiyev"
    },
    {
      "affiliations": [
        "Radiology Department, University Hospital St Ivan Rilski, Sofia, Bulgaria"
      ],
      "name": "Stanimir Sirakov"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Philipps University of Marburg, Marburg, Hesse, Germany"
      ],
      "name": "Weis Naziri"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Philipps University of Marburg, Marburg, Hesse, Germany"
      ],
      "name": "Mohammad Almohammad"
    },
    {
      "affiliations": [
        "Radiology and Nuclear Medicine, Schwarzwald-Baar Hospital Villingen-Schwenningen, Villingen-Schwenningen, Germany"
      ],
      "name": "Muhammad Almatter"
    },
    {
      "affiliations": [
        "Städtisches Klinikum Karlsruhe, Institut für Neuroradiologie, Karlsruhe, Baden württemberg, Germany"
      ],
      "name": "Safwan Roumia"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Emergency Care Research Institute, Chisinau, Moldova (the Republic of)"
      ],
      "name": "Andrei Filioglo"
    },
    {
      "affiliations": [
        "Klinik für Neuroradiologie, Klinikum Stuttgart Katharinenhospital, Stuttgart, Germany"
      ],
      "name": "Ali Khanafer"
    }
  ],
  "title": "Single versus dual antiplatelet therapy in treatment for distal intracranial aneurysms using surface-modified flow diverter (p48 MW HPC)",
  "uid": "dbdcefca-44ce-5cc8-a22e-3f89f8ef1880"
}