P-008 Loading Doses of Aspirin and Clopidogrel Prior to Enterprise Stent-assisted Repair of Intracranial Aneurysm-A Single Center Experience
Authors: Lodi Y , Reddy V , Devasenapathy A , Chou J , Shehades K , Sethi K , Galyon D , Bajwa S 
Published: July 2014

Background

To prevent thromboembolic events in stent-assisted coiling of aneurysm, 5 to 7 days of being on both aspirin and clopidogrel is considered acceptable. For ruptured cases a loading doses of aspirin and clopidogrel is required at least two hours prior to stent placement. However, antiplatelet regimen in stent-assisted treatment of intracranial aneurysm is not universal and varies from center to center. There are no clear data to evaluate the use of loading dose of aspiring and clopidogrel in all consecutive cases.

Objectives

To evaluate the thromboembolic and haemorrhagic events associate with Enterprise stent-assisted repair of intracranial aneurysm using acute loading doses of aspirin and clopidogrel. Additionally, to determine the clinical and radiographic outcome of those patients who received enterprise stent and loading doses of antiplatelet.

Methods

Consecutive patients underwent enterprise stent-assisted repair of aneurysm using loading doses of aspirin 324 mg (4 baby aspirin) and clopidogrel 300 mg 2 to 4 h prior to the procedure were enrolled. Patient's demographics including intra-operative and post operative events were recorded. The outcome was measured using national institute of health stroke scale (NIHSS) and modified Rankin Scale (mRS) score.

Results

58 patients (5 had baseline mRS 2) with mean age of 53 ± 13 underwent 67 stent-assisted procedures including two Y-stent neck reconstructions to treat 65 (2 ruptured cases) intracranial aneurysms. Stent deployment was achieved in all (98%) but one who underwent primary coiling of aneurysm. There was no intra-operative rupture or intracranial haemorrhage, but small perioperative left hemispheric subarachnoid haemorrhage was observed in one with right middle cerebral artery aneurysm. Intra-operative asymptomatic left MCA branch occlusion developed in one who had failed deployment of sent. Patient's MCA was recanalised using intra-arterial eptifibatide and discharged home in the following day with NIHSS 0. Post-operative thromboembolic events was observed in 2 cases (1.5%); first event developed day 2 with NIHSS 6 in a 42 years old woman with a giant right ICA giant aneurysm and who recovered completely (NIHSS 0, mRS 0) in 90days. The second event was visual distortion and diplopia (NIHSS 0) developed on day 2 in a 66 years old woman with basilar artery aneurysm. Her symptoms resolved completely and return to work. Immediate complete and near complete obliteration of aneurysm was observed in 66% and subtotal in 34%. There was no mortality or permanent disability in our series. 90 days mRS 0 and 1 was observed in 96% and mRS 2 in 4%.

Outcome

There was no mortality or permanent disability in our series. Good outcome

Conclusions

Using loading doses of aspirin and clopidogrel in Enterprise stent-assisted repair of intracranial aneurysm is not only safe and feasible but associated with good clinical outcome. Therefore, loading doses of aspirin and clopidogrel is an alternative option for patients who are candidates for stent-assisted repair of intracranial aneurysm.

Disclosures

Y. Lodi: None. V. Reddy: None. A. Devasenapathy: None. J. Chou: None. K. Shehades: None. K. Sethi: None. D. Galyon: None. S. Bajwa: None.