Association of preprocedural antiplatelet use with decreased thromboembolic complications for intracranial aneurysms undergoing intrasaccular flow disruption
Authors: Diestro Jose Danilo Bengzon , Adeeb Nimer , Musmar Basel , Salim Hamza , Aslan Assala , Cancelliere Nicole M. , McLellan Rachel M. , Algin Oktay , Ghozy Sherief , Lay Sovann V. , Guenego Adrien , Renieri Leonardo , Carnevale Joseph , Saliou Guillaume , Mastorakos Panagiotis , El Naamani Kareem , Shotar Eimad , Premat Kevin , Möhlenbruch Markus , Kral Michael , Bernstock Joshua D. , Doron Omer , Chung Charlotte , Salem Mohamed M. , Lylyk Ivan , Foreman Paul M. , Vachhani Jay A. , Shaikh Hamza , Župančić Vedran , Hafeez Muhammad U. , Catapano Joshua , Waqas Muhammad , Ibrahim Mohamed K. , Mohammed Marwa A. , Imamoglu Cetin , Bayrak Ahmet , Rabinov James D. , Ren Yifan , Schirmer Clemens M. , Piano Mariangela , Kühn Anna L. , Michelozzi Caterina , Elens Stéphanie , Starke Robert M. , Hassan Ameer E. , Ogilvie Mark , Nguyen Anh , Jones Jesse , Brinjikji Waleed , Nawka Marie T. , Psychogios Marios , Ulfert Christian , Pukenas Bryan , Burkhardt Jan-Karl , Huynh Thien , Martinez-Gutierrez Juan Carlos , Essibayi Muhammed Amir , Sheth Sunil A. , Spiegel Gary , Tawk Rabih G. , Lubicz Boris , Panni Pietro , Puri Ajit S. , Pero Guglielmo , Nossek Erez , Raz Eytan , Killer-Oberpfalzer Monika , Griessenauer Christoph J. , Asadi Hamed , Siddiqui Adnan , Brook Allan L. , Altschul David , Spears Julian , Marotta Thomas R. , Ducruet Andrew F. , Albuquerque Felipe C. , Regenhardt Robert W. , Stapleton Christopher J. , Kan Peter , Kalousek Vladimir , Lylyk Pedro , Boddu Srikanth , Knopman Jared , Aziz-Sultan Mohammad A. , Tjoumakaris Stavropoula I. , Jabbour Pascal M. , Clarençon Frédéric , Limbucci Nicola , Cuellar-Saenz Hugo H. , Mendes Pereira Vitor , Patel Aman B. , Dmytriw Adam A. 
Published: May 2024

OBJECTIVE
This study was conducted to investigate the impact of antiplatelet administration in the periprocedural period on the occurrence of thromboembolic complications (TECs) in patients undergoing treatment using the Woven EndoBridge (WEB) device for intracranial wide-necked bifurcation aneurysms. The primary objective was to assess whether the use of antiplatelets in the pre- and postprocedural phases reduces the likelihood of developing TECs, considering various covariates.

METHODS
A retrospective multicenter observational study was conducted within the WorldWideWEB Consortium and comprised 38 academic centers with endovascular treatment capabilities. Univariable and multivariable logistic regression analyses were performed to determine the association between antiplatelet use and TECs, adjusting for covariates. Missing predictor data were addressed using multiple imputation.

RESULTS
The study comprised two cohorts: one addressing general thromboembolic events and consisting of 1412 patients, among whom 103 experienced TECs, and another focusing on symptomatic thromboembolic events and comprising 1395 patients, of whom 50 experienced symptomatic TECs. Preprocedural antiplatelet use was associated with a reduced likelihood of overall TECs (OR 0.32, 95% CI 0.19–0.53, p < 0.001) and symptomatic TECs (OR 0.49, 95% CI 0.25–0.95, p = 0.036), whereas postprocedural antiplatelet use showed no significant association with TECs. The study also revealed additional predictors of TECs, including stent use (overall: OR 4.96, 95% CI 2.38–10.3, p < 0.001; symptomatic: OR 3.24, 95% CI 1.26–8.36, p = 0.015), WEB single-layer sphere (SLS) type (overall: OR 0.18, 95% CI 0.04–0.74, p = 0.017), and posterior circulation aneurysm location (symptomatic: OR 18.43, 95% CI 1.48–230, p = 0.024).

CONCLUSIONS
The findings of this study suggest that the preprocedural administration of antiplatelets is associated with a reduced likelihood of TECs in patients undergoing treatment with the WEB device for wide-necked bifurcation aneurysms. However, postprocedural antiplatelet use did not show a significant impact on TEC occurrence.