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Single-antiplatelet regimen in ruptured cerebral blood blister aneurysms treated with flow diverter stent with surface modification
1108 14:10-14:20
Cerebrovascular/304B
Background Ruptured cerebral blood blister aneurysms (BBA) are challenging without definite treatment methods. Flow diversion treatment of ruptured cerebral aneurysms remains debated due to the need for double-antiplatelet therapy. We report our experience with flow-diverter stent (FDS) reconstruction with single antiplatelet therapy of ruptured cerebral blood blister aneurysms. Methods In this case series we performed a retrospective analysis of all patients with ruptured cerebral aneurysms who were treated with a phosphoryl-bonded FDS between 2020 and 2024 in a single center. Peri-procedurally, all patients received IA and IV Tirofiban. After 24 hours, Tirofiban was switched to oral Ticagrelor as monotherapy. We analyzed the rate of bleeding complications, thromboembolic events, occlusion rate and clinical outcome. Results Seven patients with subarachnoid hemorrhage were treated, four within 72 hours of symptom onset. Six patients were treated with one FDS and two patients received two FDS in a telescopic fashion. Four aneurysms were additionally coil embolized. Four patients accept further shunt surgery, but no bleeding complications happened. No re-rupture occurred, and all patients survived and had no adverse events associated with the FDS. Six patients showed complete occlusion of the aneurysm after 6 months (n=4) and 1 year (n=2), respectively. One patient had no loss follow-up. Favorable clinical outcome was achieved in all patients. Conclusions Peri-interventional single-antiplatelet therapy with Tirofeban followed by Ticagrelor was sufficient to prevent thromboembolic events and reduce re-bleeding using an anti-thrombogenic FDS. FDS with single-antiplatelet therapy might be a reasonable option for ruptured blood blister and dissecting cerebral aneurysms.