Page 34 - ITPS-7-1

INNOSC Theranostics and
Pharmacological Sciences Antiplatelet treatments in neurological patients

coiling alone. As aspirin only partially inhibits intracranial aneurysm are considered at significant
GPIIb/IIIa, it provides a low barrier effect on the risk risk for thromboembolism. Edwards et al. found that
of a thromboembolic event . Postoperatively, coiling periprocedural monotherapy in the form of aspirin can
[71]
alone does not generally indicate prolonged antiplatelet significantly reduce periprocedural thromboembolic
or anticoagulant therapy, both mono and dual therapy, events without significantly increasing hemorrhage risk
particularly after the point of discharge . The addition even in ruptured aneurysm and subarachnoid hemorrhage
[72]
[74]
of a stent may require an antiplatelet/anticoagulation cases . Of note, treatment cohorts received intraoperative
therapy regimen postoperatively. Aside from prior medical aspirin at 650 mg near the end of the procedure. This
histories such as atrial fibrillation that necessitates chronic group continued on aspirin 325 mg once daily for 2 weeks.
medication; antiplatelet/anticoagulation therapy in cases In comparison, the control group received no aspirin or
[74]
of simple coiling is usually confined within the duration any other antiplatelet/anticoagulant agents . Despite
of a hospital course. Given resistance to antiplatelet agents trends in randomized controlled trials, multiple factors,
may be a possibility, prolonged therapy that is not indicated in addition to whether or not an aneurysm has ruptured,
for would not be a practical option . The advantages must be considered to provide the ideal antiplatelet/
[73]
and disadvantages of endovascular coiling for cerebral anticoagulant therapy mode for each patient undergoing
aneurysms are listed in Table 1. endovascular coiling. Parameters include medical
history, extent of procedure, recovery, follow-up status,
In the case of ruptured aneurysm and subarachnoid and magnetic resonance angiography assessment. In
hemorrhage, antiplatelet/anticoagulant therapy standards less frequent cases suffering from intraoperative clotting
are distinct from the cases previously discussed, despite having received antiplatelet therapy, glycoprotein
as subarachnoid hemorrhage was observed to be IIb/IIIa inhibitors such as abciximab may prove effective
independently linked to thromboembolic complications in producing fast-onset platelet inhibition . However, the
[40]
associated with endovascular coiling . In these cases, safety and efficacy of these drugs must be further studied
[65]
anticoagulant therapy can be initiated in the form of to determine accurate timing, dosing, and administration
subcutaneous heparin approximately 12 h after CE. route for successful treatment in patients.
Supplemental aspirin administration may be flexible
but has to be administered at the discretion of the 6. SAC
neurointerventional provider . More care must be taken
[72]
to assess the appropriate antiplatelet therapy when dealing Although coiling has been used successfully for aneurysm
with CE of ruptured aneurysms. Patients with ruptured repair, it can prove to be a difficult process. Aneurysms
can occur in numerous locations with a wide variety of
shapes, dimensions, and rupture capacities . Stabilizing
[75]
Table 1. Advantages and disadvantages of endovascular the aneurysm is one way to minimize the risks of coiling
coiling for cerebral aneurysm without reducing its advantageous effects. This stabilization
Advantages Disadvantages can be engineered by utilizing a stent. In SAC, a stent can
Coiling alone be placed within an aneurysm to bolster its shape, allowing
for secure coil deposition . The endovascular technique
[76]
Minimally invasive Ruptured aneurysms cannot used in SAC is minimally invasive, accompanied by a
be treated with coiling alone;
stent/balloon may be required high success rate, and a reduced risk of complications
Quicker recovery Requires blood thinners to in comparison to other options available for treating
prevent coagulation of coil aneurysms. Hence, it has the potential to significantly
SAC improve outcomes in cerebral aneurysm coiling.
Lower rates of aneurysm Increased mortality rate SAC was originally used to treat wide-necked
recurrence aneurysms [58,59] . Not only did it provide structural support to
Can be used for wide-necked Difficulty visualizing aneurysms bolster the coils in the wide aneurysm sac, but it also prevented
[77]
aneurysms using fluorescence the coils from protruding into the parent artery . Coil
WEB embolization migration affects 14% of patients undergoing aneurysm
Adaptable to wide-necked and Not indicated for aneurysms that coiling, and its effects are relatively understudied and
bifurcation aneurysms are not wide-necked can range from life-threatening infarcts to no significant
[78]
Reduced intraoperative time and Prevalence of recanalization thromboembolic impact . Using a mesh design for a stent
long-term antiplatelet therapy; postoperatively helps maintain unobstructed blood flow while preventing
increased safety the movement of coils out of the aneurysm sac. Further,
Abbreviations: SAC: Stent-assisted coiling; WEB: Woven EndoBridge. the development of more flexible intravascular stents over

Volume 7 Issue 1 (2024) 6 https://doi.org/10.36922/itps.1202