Page 32 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Antiplatelet treatments in neurological patients

diminish the efficacy of the intervention . One possible
[40]
complication that carries significant risk is the development
of a thromboembolism . Thromboembolisms are
[40]
more inclined to attach to devices such as catheters due
to repeated damage to the vascular walls . Therefore,
[40]
anticoagulation agents, such as heparin, and antiplatelet
agents are commonly employed to decrease risk of
thromboembolism. The use of antiplatelet agents before
and during the procedure is deemed safe and efficacious
in reducing the risk of a thromboembolism for unruptured
aneurysms . Antiplatelet agents, such as aspirin and
[40]
clopidogrel, show evidence of reducing thromboembolism
risk in coronary angiography and coronary endovascular
interventions . Aspirin works by irreversibly inhibiting
[41]
the enzyme, cyclooxygenase-1 (COX1), preventing the
conversion of arachidonic acid to thromboxane A2 .
[42]
Conventionally, aspirin and clopidogrel are used in
combination during aneurysm coiling and have shown
to reduce thromboembolic events . Heparin is an
[43]
anticoagulant that is not traditionally used in diagnostic
angiographic procedures but may be used in coiling
procedures for patients with uninterpreted aneurysms .
[44]
Heparin use has shown to be efficacious in selected cases
where there is cerebral ischemia or coil migration into
Figure 3. Impact of administering a microcatheter-deployed coiling to the lumen of the parent vessel, but the use of heparin in
patients suffering from intracranial or intracerebral aneurysms. ruptured aneurysms is not indicated . Current guidelines
[44]
recommend the use of DAPT for 3 – 6 months, but a meta-
helical platinum coils are deployed to fill the aneurysm analysis published in 2021 found that single antiplatelet
and prevent further expansion . Compared to FDD, therapy involving aspirin reduced bleeding without raising
[35]
CE devices have shown relatively low rates of complete the risk for stroke or death .
[45]
occlusion but unfortunately are correlated with high rates of
recurrence, especially when used to treat large intracranial Abciximab is a Fab monoclonal antibody which blocks
[40]
aneurysms . Stent-assisted CE has been shown to achieve the IIb/IIIa receptor to inhibit platelet blockade . Its
[36]
more optimal outcomes compared to traditional CE but effects occur within 10 min of administration and may
[46]
still faces high recurrence rates of 20 – 57% in treated persist for up to 48 h . Abciximab inhibits platelets
[47]
patients [37,38] . throughout the duration of intravenous infusion . One
study found that abciximab engendered a better response
On the other hand, WEB embolization is a device to clots in aneurysm coiling procedures, which were
used to disrupt flow along the neck of the aneurysm . complicated by the formation of a thrombus . Therefore,
[39]
[48]
This device functions as an intrasaccular flow diverter by abciximab proves to be efficacious for intra-procedural
placing a metabolic mesh along the wall of the aneurysm thrombus formation. In addition, the risk of hemorrhagic
and the neck . It is designed as a stand-alone therapy complications is reduced in both unruptured and ruptured
[39]
for the management of saccular aneurysms, unruptured aneurysms .
[40]
or ruptured . Other flow-disruption devices require the
[39]
use of dual antiplatelet therapy (DAPT), while data suggest 5. Coiling
that the WEB device may be placed without the need for Endovascular coiling or embolization and open
DAPT due to the high degree of neck coverage . microsurgical clipping are considered the main standard
[39]
4. Protocol for antiplatelets and non-conservative preventive treatment options in patients
anticoagulant therapy afflicted by unruptured cerebral aneurysms in addition
to arteriovenous malformations . In general, surgical
[49]
Although neurointerventional surgery offers benefits clipping is commonly performed in younger patients,
to patients with neurovascular diseases and stroke, especially those admitted due emergency . During the
[50]
the complications are difficult to avoid and ultimately non-SAC process, a wired catheter is passed through the
Volume 7 Issue 1 (2024) 4 https://doi.org/10.36922/itps.1202