Triple Therapy, VBA Aneurysm - 2022
Triple Therapy versus Dual-antiplatelet Therapy for Dolichoectatic Vertebrobasilar Fusiform Aneurysms Treated with Flow Diverters | Journal of NeuroInterventional Surgery
In this paper[1], the authors investigated the utilization of Triple Therapy (TT) in the management of the dolichoectatic vertebrobasilar fusiform aneurysms treated with flow diverters. They concluded that compared with Dual-antiplatelet Therapy (DAPT), TT group had fewer ischemic strokes, less symptom progression, and overall better outcomes at last follow-up.
Study Specifics
- Journal: Journal of NeuroInterventional Surgery
- Publication history
- First published: September 7, 2022.
- Online issue publication: June 16, 2023.
- Study type
- Retrospective cohort study.
- Multi-centers in the U.S. (8)
- Interval: 2012-2020
- Aneurysm
- Unruptured
- Fusiform dolichoectatic
- Involves at least one segment of the VB
- Treated with flow diverter
- Groups
- DAPT
- TT
- Anti-thrombotic specifics
- DAPT 7-10 days prior to intervention (all patients)
- Intravenous heparin during the procedure (all patients)
- Oral anticoagulation (TT)
- DAPT for at least 6 months (all patients)
- Single anti-platelet for life (all patients)
- Total patients: 27
- TT: 14
- DAPT: 13
- Median length of angiographic follow-up
- TT: 468 days
- DAPT: 280 days
- Complete occlusion (P=0.213)
- TT: 25% (3/12)
- DAPT: 54.4% (6/11)
- Statistically significantly difference
- Radial access: 0.006 (TT>DAPT)
- Overall mRS score decline: 0.001 (DAPT>TT)
- Moderate-to-severe disability at last follow-up: 0.007 (DAPT>TT)
Reference Points
- The anticoagulant dosage used ranged from 5 to 20 mg of rivaroxaban and 5 to 10 mg of apixaban.
- Mean duration of oral anti-coagulation therapy in TT group was 190 days.
- Telescoping multiple flow diverters should be kept to a minimum.
- Adjunctive coiling could be used to reduce mural flow and also to support the mesh, avoiding its prolapse into large fusiform sacs.
- Dual therapy was associated with less risk of intracranial hemorrhage and major bleeding than TT, with no difference in risk of ischemic stroke, myocardial infarction, or stent thrombosis.
- Cekirge and Saatci described the concept of stable remodeling for aneurysms that do not present angiographic occlusion but remain stable for a long period of time.[2]