The Impact of Dual Antiplatelet Therapy Duration on Unruptured Aneurysm Occlusion after Flow Diversion: A Multicenter Study

Justin E. Vranic*, Pablo Harker, Christopher J. Stapleton, Robert W. Regenhardt, Adam A. Dmytriw, Omer M. Doron, Naif M. Alotaibi, Thabele M. Leslie-Mazwi, Rajiv Gupta, Inka K. Berglar, Can Ozan Tan, Matthew J. Koch, Scott B. Raymond, Justin R. Mascitelli, T. Tyler Patterson, Joshua Seinfeld, Andrew White, David Case, Christopher Roark, Chirag D. GandhiFawaz Al-Mufti, Jared Cooper, Charles Matouk, Nanthiya Sujijantarat, Diego A. Devia, Maria I. Ocampo-Navia, Daniel E. Villamizar-Torres, Juan C. Puentes, Aman B. Patel

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Objective Endoluminal flow diversion reduces blood flow into intracranial aneurysms, promoting thrombosis. Postprocedural dual antiplatelet therapy (DAPT) is necessary for the prevention of thromboembolic complications. The purpose of this study is to therefore assess the impact that the type and duration of DAPT has on aneurysm occlusion rates and iatrogenic complications after flow diversion. Methods A retrospective review of a multicenter aneurysm database was performed from 2012 to 2020 to identify unruptured intracranial aneurysms treated with single device flow diversion and ≥12-month follow-up. Clinical and radiologic data were analyzed with aneurysm occlusion as a function of DAPT duration serving as a primary outcome measure. Results Two hundred five patients underwent flow diversion with a single pipeline embolization device with 12.7% of treated aneurysms remaining nonoccluded during the study period. There were no significant differences in aneurysm morphology or type of DAPT used between occluded and nonoccluded groups. Nonoccluded aneurysms received a longer mean duration of DAPT (9.4 vs 7.1 months, P = 0.016) with a significant effect of DAPT duration on the observed aneurysm occlusion rate (F(2, 202) = 4.2, P = 0.016). There was no significant difference in the rate of complications, including delayed ischemic strokes, observed between patients receiving short (≤6 months) and prolonged duration (>6 months) DAPT (7.9% vs 9.3%, P = 0.76). Conclusions After flow diversion, an abbreviated duration of DAPT lasting 6 months may be most appropriate before transitioning to low-dose aspirin monotherapy to promote timely aneurysm occlusion while minimizing thromboembolic complications.

Original languageEnglish
Pages (from-to)753-758
Number of pages6
JournalJournal of Computer Assisted Tomography
Issue number5
StatePublished - 1 Sep 2023
Externally publishedYes


  • aneurysm
  • antiplatelet therapy
  • endovascular
  • flow diversion


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