Key result
Three-month DAPT shows similar ischemic stroke rates to prolonged DAPT after Pipeline Shield flow diversion.
Why the study?
The optimal duration of dual antiplatelet therapy (DAPT) after flow diversion remains uncertain, as the incremental benefit and risk of extending therapy beyond the early postprocedural period are unclear.
Does discontinuing dual antiplatelet therapy at approximately 3 months (76-104 days) increase ischemic risk or alter hemorrhagic risk compared with prolonged therapy (≥105 days) in patients with unruptured intracranial aneurysms treated with Pipeline Embolization Devices with Shield Technology?
Cohort (n=721)
Yes
Does discontinuing dual antiplatelet therapy at approximately 3 months (76-104 days) increase ischemic risk or alter hemorrhagic risk compared with prolonged therapy (≥105 days) in patients with unruptured intracranial aneurysms treated with Pipeline Embolization Devices with Shield Technology?
Discontinuing dual antiplatelet therapy at approximately 3 months after Pipeline flow diversion with Shield Technology for unruptured intracranial aneurysms was not associated with increased ischemic risk compared with prolonged therapy, supporting the potential feasibility of shorter DAPT regimens in selected patients.
Answers are grounded in this paper and cite their sources.
Low ischemic stroke rates after day 75 showed no regimen difference; leaves open optimal long-term antiplatelet strategy.
Background The optimal duration of dual antiplatelet therapy (DAPT) after flow diversion remains uncertain. Although prolonged DAPT is commonly used, the incremental benefit and risk of extending therapy beyond the early postprocedural period are unclear. Methods We retrospectively analyzed prospectively collected data from three post-market registries (PFLEX, SHIELD, INSPIRE-A) of patients treated with Pipeline Embolization Devices with Shield Technology for unruptured intracranial aneurysms. Patients receiving aspirin plus a P2Y12 inhibitor were categorized as approximately 3-month DAPT (76–104 days) or prolonged DAPT (≥105 days). Events occurring after day 75 were compared using unadjusted and propensity score-adjusted analyses. Results Among 721 patients, 172 received 76–104-day DAPT, and 549 received prolonged DAPT. After day 75, ischemic complications were rare and did not differ between groups (any ischemic stroke: 1.2% (2/172) vs 0.5% (3/549); adjusted P=0.23). Hemorrhagic events were also uncommon, with no differences in major hemorrhage (0.0% (0/172) vs 0.9% (5/549); adjusted P=0.23) or minor hemorrhage (0.0% (0/172) vs 0.5% (3/549); adjusted P=0.39). Exploratory analyses showed that hemorrhagic events occurred mainly during active DAPT, whereas ischemic and thromboembolic events occurred during and after treatment, without a clear increase after discontinuation. Conclusions DAPT discontinuation at approximately 3 months was not associated with increased ischemic risk compared with prolonged therapy. Given the low event rates and lack of evident benefit from extended treatment, an approximately 3-month DAPT strategy may be reasonable in selected patients, pending prospective confirmation.
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Hohenstatt et al. (2026) conducted a cohort in Unruptured intracranial aneurysms treated with Pipeline Embolization Devices with Shield Technology (n=721). Approximately 3-month dual antiplatelet therapy (aspirin plus P2Y12 inhibitor) vs. Prolonged dual antiplatelet therapy (≥105 days) was evaluated on Any ischemic stroke occurring after day 75 (p=0.23). Approximately 3-month DAPT after Pipeline flow diversion with Shield Technology had similar ischemic stroke rates after day 75 compared with prolonged DAPT (1.2% vs 0.5%; adjusted P=0.23).
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