Two of these 3 patients were switched to prasugrel (10 mg/day), and 1 patient with a history of deep venous thrombosis was maintained on preoperative warfarin (5 mg/day). Platelet inhibition testing results showed that no patients had aspirin resistance and that 3 patients had clopidogrel resistance. One of the 9 patients with an unruptured aneurysm refused clopidogrel pretreatment and only took aspirin 325 mg/day. There were no instances of AICA-PICA complex.
The average aneurysm size was 9.3 ± 4.9 mm in maximal dimension, and 4 of 13 (30.8%) were ruptured at presentation. Thirteen patients (mean age, 61.3 ± 12.4 years) met inclusion criteria. In cases in which aneurysm coils were placed, a separate microcatheter was jailed within the aneurysm dome before FDS placement.
Multiple devices were placed at the discretion of the surgeon for optimal aneurysm coverage. Intravenous heparin was administered to maintain an activated clotting time of at least 250 seconds. 5 All endovascular procedures were performed with the patient under general anesthesia, with neurophysiologic monitoring, and via transfemoral transarterial access. The technique of FDS deployment has been described previously. All the patients were maintained on antiplatelet therapy for 6 months after the index procedure, after which only aspirin (81 mg/day) was continued. Platelet inhibition testing was used to determine patient response to aspirin and clopidogrel. Patients with ruptured aneurysms were treated with a single 0.125 mg/kg intraprocedural bolus of intravenous or intra-arterial abciximab after stent placement instead of dual antiplatelet pretreatment. Initial postprocedure and follow-up angiography images were reviewed to determine the immediate and midterm PICA patency rate after FDS placement.Īll but one of the patients with unruptured aneurysms were pretreated with aspirin (325 mg/day) and clopidogrel (75 mg/day) for at least 3 days before the procedure. Patient demographics, aneurysm rupture status, the number of stent devices deployed, the presence of adjunctive aneurysm coiling, antiplatelet medication reactivity testing, and the postoperative stroke rate were recorded. Review of our prospective endovascular data base was performed, and all the patients with vertebral and vertebrobasilar artery aneurysms who were treated between May 2011 and May 2015 with an FDS in which one or more devices spanned the ostium of the PICA were identified. This study was approved by the institutional review board of St.
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