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
- 38 Downloads
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.
KeywordsPlatelet function Antithrombotic coating Flow diversion
- Chang HS, Yamato O, Sakai Y, Yamasaki M, Maede Y. Acceleration of superoxide generation in polymorphonuclear leukocytes and inhibition of platelet aggregation by alk(en)yl thiosulfates derived from onion and garlic in dogs and humans. Prostaglandins Leukot Essent Fatty Acids. 2004;70(1):77–83.CrossRefGoogle Scholar
- Chang HS, Yamato O, Yamasaki M, Maede Y. Modulatory influence of sodium 2-propenyl thiosulfate from garlic on cyclooxygenase activity in canine platelets: possible mechanism for the anti-aggregatory effect. Prostaglandins Leukot Essent Fatty Acids. 2005;72(5):351–5. https://doi.org/10.1016/j.plefa.2005.01.003.CrossRefPubMedGoogle Scholar
- Lenz-Habijan T, Bhogal P, Peters M, Bufe A, Martinez Moreno R, Bannewitz C, Monstadt H, Henkes H. Hydrophilic stent coating inhibits platelet adhesion on stent surfaces: initial results in vitro. Cardiovasc Intervent Radiol. 2018;41(11):1779–85. https://doi.org/10.1007/s00270-018-2036-7.CrossRefPubMedPubMedCentralGoogle Scholar
- Martínez-Galdámez M, Biondi A, Kalousek V, Pereira VM, Ianucci G, Gentric JC, Mosimann PJ, Brisbois D, Schob S, Quäschling U, Kaesmacher J, Ognard J, Escartín J, Tsang COA, Čulo B, Chabert E, Turjman F, Barbier C, Mihalea C, Spelle L, Chapot R. Periprocedural safety and technical outcomes of the new Silk Vista Baby flow diverter for the treatment of intracranial aneurysms: results from a multicenter experience. J Neurointerv Surg. 2019. https://doi.org/10.1136/neurintsurg-2019-014770.CrossRefGoogle Scholar
- Schob S, Hoffmann KT, Richter C, Bhogal P, Köhlert K, Planitzer U, Ziganshyna S, Lindner D, Scherlach C, Nestler U, Meixensberger J, Quäschling U. Flow diversion beyond the circle of Willis: endovascular aneurysm treatment in peripheral cerebral arteries employing a novel low-profile flow diverting stent. J Neurointerv Surg. 2019. https://doi.org/10.1136/neurintsurg-2019-014840.