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This comprehensive review delves into the evolving field of neurointervention for intracranial aneurysms, exploring the critical adjunct of Dual Antiplatelet Therapy (DAPT) to endovascular coiling, stent-assisted coiling (SAC), flow-diversion stents, and flow-disruption (intrasaccular) devices. Despite growing evidence supporting the success of DAPT in reducing thromboembolic events, the lack of consensus on optimal regimens, doses, and duration is evident. Factors contributing to this variability include genetic polymorphisms affecting treatment response and ongoing debates regarding the clinical significance of hemorrhagic complications associated with DAPT. This review analyzes pre- and post-procedural antiplatelet usage across various interventions. The imperative lies in ongoing research to define optimal DAPT durations, ensuring a nuanced approach to the delicate balance between thrombosis and hemorrhage in intracranial aneurysm management.
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http://dx.doi.org/10.1007/s00701-024-06137-4 | DOI Listing |
Am J Cardiol
September 2025
Interventional Cardiology, Mediterranea Cardiocentro, Naples, Italy.
Am J Med Sci
September 2025
Division of Gastroenterology and Hepatology, Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama, USA.
Background: Metabolic dysfunction-associated steatohepatitis (MASH) cirrhosis is now the second leading indication for liver transplantation (LT) worldwide and is associated with increased risk of cardiovascular events before and after LT. Cirrhotics who undergo left heart catheterization (LHC) with coronary artery stenting for LT evaluation require dual-antiplatelet therapy (DAPT). Data regarding the safety, risk of gastrointestinal (GI) bleeding, and mortality risk of cirrhotics receiving DAPT is limited.
View Article and Find Full Text PDFJ Diabetes
September 2025
Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Shanghai, China.
Background: Despite increased risk of ischemic events in diabetes, the optimal anti-thrombotic strategy for secondary prevention has not been defined. We aimed to assess the efficacy and safety of optimal antiplatelet agents such as indobufen-based dual antiplatelet therapy (DAPT) in patients with diabetes after coronary stenting.
Methods: OPTION trial was a randomized, open-label, noninferiority, and multicentric study in China.
Eur Heart J Case Rep
September 2025
Cardio-Thoracic-Vascular Department, Cardiology Unit, Azienda Ospedaliera Carlo Poma, ASST Mantova, Str. Lago Paiolo 10, Mantova 46100, Italy.
Background: While advances in technology and procedural techniques have significantly improved outcomes post-PCI, two pharmacological strategies have gained particular attention for their effectiveness in reducing long-term cardiovascular (CV) risk: anti-platelet therapies and lipid-lowering therapies (LLT). The 10-year recurrence risk for major CV events remains as high as 10-30%, due to various pathophysiological pathways collectively known as residual risk (RR), even with optimal CV risk factor management after acute coronary syndrome (ACS). RR includes factors such as elevated lipoprotein(a) [Lp(a)], triglycerides, pro-thrombotic states, hyperglycemia, and persistent subclinical arterial inflammation.
View Article and Find Full Text PDFJ Neurointerv Surg
September 2025
Department of Neurology, Division of Neurosurgery, Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, São Paulo, Brazil.
Background: Blister-like intracranial aneurysms are rare fragile lesions with a high risk of rupture leading to acute subarachnoid hemorrhage (aSAH) and significant morbidity. Flow diversion (FD) has emerged as a promising endovascular treatment, particularly for complex cases unsuitable for clipping or coiling, but evidence in ruptured settings remains limited due to challenges such as the risks of dual antiplatelet therapy. This study aimed to evaluate the efficacy and safety of FD in ruptured blister-like aneurysms during aSAH through a systematic review and meta-analysis.
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