Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis

Anna Podlasek, Abdul Aziz Al Sultan, Zarina Assis, Nima Kashani, Mayank Goyal, Mohammed A. Almekhlafi (Lead / Corresponding author)

    Research output: Contribution to journalArticlepeer-review

    31 Citations (Scopus)


    Background Thromboembolic complications are not uncommon in patients undergoing neurointerventional procedures. The use of flow diverting stents is associated with higher risks of these complications despite current dual antiplatelet regimens. 

    Objective To explore contemporary evidence on the safety of emerging dual antiplatelet regimens in flow diverting stenting procedures. 

    Methods We performed a systematic review and meta-analysis to identify relevant articles in electronic databases, and relevant references. Studies reporting the complications and mortality of flow diverting stenting procedures using acetyl salicylic acid (ASA) + ticagrelor or ASA + prasugrel compared with ASA + clopidogrel were included. 

    Results Of 452 potentially relevant studies, we identified 49 studies (2526 patients) which reported the safety of ticagrelor or prasugrel for pooled analysis, and five studies (1005 patients) for meta-analysis. The pooled overall mortality in all studies was 2.14%, ischemic complications 6.89%, and hemorrhagic complications 3.68%. The use of ticagrelor or prasugrel was associated with a lower risk of mortality compared with clopidogrel (RR=4.57, 95% CI 1.23 to 16.99; p=0.02). Considering ischemic events, ASA + clopidogrel was as safe as ASA + prasugrel (RR=0.55, 95% CI 0.11 to 2.74; p=0.47) and ASA + ticagrelor (RR=0.74, 95% CI 0.32 to 1.74; p=0.49). ASA +ticagrelor was not associated with a higher risk of hemorrhagic complications (RR=0.92, 95% CI 0.27 to 3.16; p=0.89). 

    Conclusions Evidence suggests that dual antiplatelet regimens including ticagrelor or prasugrel are safe for patients undergoing flow diversion procedures. Regimens using ticagrelor were associated with better survival than those using clopidogrel in the included studies.

    Original languageEnglish
    Pages (from-to)148-155
    Number of pages9
    JournalJournal of Neurointerventional Surgery
    Issue number2
    Early online date4 Jul 2019
    Publication statusPublished - 1 Feb 2020

    ASJC Scopus subject areas

    • Surgery
    • Clinical Neurology


    Dive into the research topics of 'Outcome of intracranial flow diversion according to the antiplatelet regimen used: a systematic review and meta-analysis'. Together they form a unique fingerprint.

    Cite this