Anterior Cerebral Artery (A1 Segment) Aneurysm: Abandoned Dual Platelet Inhibition Shortly After Endovascular Treatment with a Hydrophilic Polymer-Coated Flow Diverter p48_HPC; Good Clinical Outcome and Early Aneurysm Occlusion

Abstract

A wide-necked aneurysm originating from the proximal A1 segment of the right-hand side anterior cerebral artery (ACA) of a 33-year-old patient was diagnosed on follow-up MR imaging after the resection of an anaplastic astrocytoma WHO grade III. In order to reconstruct the parent vessel and avoid long-term dual antiplatelet therapy (DAPT), flow diversion was successfully carried out using a p48_HPC. The patient had not shown any focal neurological deficit after his initial treatment 5 years previously.

The current clinical standard stipulates that DAPT be prescribed following the implant of a flow diverter in an intracranial vessel. To this end, ASA and ticagrelor were prescribed for 12 months post procedure. However, the patient intentionally stopped his medication 4 days after discharge and continued only to take phytopharmaceuticals such as garlic and grape seed extract. Regular follow-ups with digital subtraction angiography (DSA) revealed the frequent finding of mild deformations of the ultimately patent flow diverter without any in-stent stenosis. The patient remained asymptomatic at all times after the procedure.

The pharmaceutical regimen after treatment with a coated low-profile flow diverter and its clinical potential in the context of complicating comorbidities are the main topics of this chapter.