Key result
Half-dose ticagrelor DAPT is associated with lower platelet reactivity vs standard clopidogrel but similar 30-day complications.
Why the study?
The safety and efficacy of half-dose ticagrelor DAPT for flow diverter treatment of intracranial aneurysms, particularly in Chinese patients and with PED Flex Shield, remains uncertain.
Does half-dose ticagrelor plus aspirin improve platelet reactivity and maintain perioperative safety compared to standard-dose clopidogrel plus aspirin in patients with intracranial aneurysms undergoing flow diverter treatment?
Observational (n=405)
No
Does half-dose ticagrelor plus aspirin improve platelet reactivity and maintain perioperative safety compared to standard-dose clopidogrel plus aspirin in patients with intracranial aneurysms undergoing flow diverter treatment?
Half-dose ticagrelor provides stronger platelet inhibition than standard-dose clopidogrel without increasing perioperative ischemic or hemorrhagic complications in patients undergoing flow diverter treatment for intracranial aneurysms.
Answers are grounded in this paper and cite their sources.
Half-dose ticagrelor was associated with superior platelet inhibition and similar perioperative safety versus clopidogrel; extends prior DAPT data but remains hypothesis-generating.
The safety and efficacy of half-dose ticagrelor (45 mg twice daily) dual antiplatelet therapy (DAPT) for flow diverter (FD) treatment of intracranial aneurysm (IA), particularly in Chinese patients and with PED (Pipeline embolization device) Flex Shield, remains uncertain. This study assessed whether this regimen maintains efficacy while improving safety, including its applicability to PED Flex Shield. This single-center retrospective study analyzed consecutive IA patients undergoing FD treatment between 2019–2024, comparing standard-dose clopidogrel (75 mg daily) plus aspirin (100 mg daily) with half-dose ticagrelor (45 mg twice daily) plus aspirin (100 mg daily). Outcomes included adenosine diphosphate-induced maximal platelet aggregation (ADPi-MPA) measured by light transmittance aggregometry, perioperative complications within 30 days post-procedure, and analysis of factors influencing ADPi-MPA levels. The study included 405 IA patients (half-dose ticagrelor = 224, standard-dose clopidogrel = 181). The half-dose ticagrelor group demonstrated significantly lower ADPi-MPA (26.00 [17.45, 34.25] vs 37.70 [29.50, 43.60], P < 0.001), with comparable ischemic (3.1% vs 5.5%, P = 0.114) and hemorrhagic (2.1% vs 1.2%, P = 0.689) event rates. No significant differences in perioperative complications were found between FD types (PED/PED Flex/TED vs PED Flex Shield) when using the half-dose ticagrelor regimen (all P > 0.05). Similarly, complication rates were comparable between the two DAPT regimens across both FD subgroups (all P > 0.05). This study demonstrates that half-dose ticagrelor DAPT achieves significantly lower platelet reactivity (ADPi-MPA) compared to standard-dose clopidogrel, with no statistically significant differences in ischemic or hemorrhagic complication rates observed among FD-treated IA patients. Importantly, the half-dose regimen shows consistent performance across different FD devices (including PED Flex Shield) without compromising perioperative safety.
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Li et al. (2026) conducted an observational in Adult patients (>18 years) with intracranial aneurysms undergoing flow diverter treatment (PED, PED Flex, TED, PED Flex Shield) at a single center in China (n=405). Half-dose ticagrelor plus aspirin vs. Standard-dose clopidogrel plus aspirin was evaluated on Perioperative complications within 30 days post-procedure including ischemic and hemorrhagic events (p=0.743). Half-dose ticagrelor plus aspirin dual antiplatelet therapy resulted in significantly lower platelet reactivity (median ADPi-MPA 26.00% vs 37.70%, P < 0.001) with no significant difference in 30-day perioperative ischemic (3.1% vs 5.5%, P = 0.114) or hemorrhagic complication rates (2.1% vs 1.2%, P = 0.689) compared to standard-dose clopidogrel plus aspirin in flow diverter-treated intracranial aneurysm patients.
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