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Master Thesis

Double antiagrégation plaquettaire par ticagrelor versus clopidogrel lors de l'embolisation d'anévrismes intracraniens non rompus par stent à diversion de flux

Abstract : Background and purpose: antiplatelet therapy (APT) is a key element limiting the risk of thromboembolic events in neuroendovascular treatments, including endovascular treatment of intracranial aneurysms with stents. To date, clopidogrel combined with aspirin is the mostly reported dual APT (DAPT). However, resistance phenomenon and intraindividual efficacy fluctuation are identified limitations. In recent years, ticagrelor, a P2Y12 antagonist, has been increasingly used for intracranial endovascular treatments. Yet, evidences are still missing in this indication. We aimed to compare these two DAPT regimens in the setting of flowdiversion for intracranial aneurysm. Methods: we conducted a multicentric retrospective study of prospectively maintained databases in two high volume centers extracting consecutive patients presenting intracranial aneurysm treated with flowdiverter between May 2015 and December 2019. Patients treated with flowdiverter and receiving associated DAPT were included. Ruptured aneurysms and other endovascular treatments were excluded. Two groups were compared according to their DAPT regimen: “ticagrelor + aspirin” and “clopidogrel + aspirin”. The primary endpoint was composite, defined as any thrombo-embolic event (TEE) or major hemorrhagic event occurring during the DAPT period. Results: 260 patients met inclusion/exclusion criteria: 104 in the ticagrelor group and 156 in the clopidogrel group. Baseline patient and aneurysm characteristics were balanced between groups except for aneurysm location, median size and pre-treatment modified Rankin scale. No significant difference was observed regarding the primary composite outcome: 9.6% (10/104) in the ticagrelor group versus 10.9% (17/156) in the clopidogrel group (p= 0.837). There were also no significant difference in secondary outcomes including TEE (9.6 vs 9.0%; p=1.000), major hemorrhage (0 vs 1.2%; p=0.277) and clinical outcome (at least 1 point mRS worsening during follow up: 6.7 vs 8.3%; p=0.705). No major bleeding was reported in the ticagrelor group. Conclusion: in our study, we found no significant difference regarding safety and efficacy of DAPT with ticagrelor or clopidogrel in the treatment of intracranial unruptured aneurysm with flowdiverter. Given its ease of use, ticagrelor may be considered as a first-line APT in this indication.
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https://dumas.ccsd.cnrs.fr/dumas-03382552
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Submitted on : Monday, October 18, 2021 - 11:39:26 AM
Last modification on : Thursday, November 25, 2021 - 3:15:46 AM

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  • HAL Id : dumas-03382552, version 1

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Jean Papaxanthos. Double antiagrégation plaquettaire par ticagrelor versus clopidogrel lors de l'embolisation d'anévrismes intracraniens non rompus par stent à diversion de flux. Sciences du Vivant [q-bio]. 2021. ⟨dumas-03382552⟩

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