Key result
Stopping SAPT at 12 months after flow diversion shows no difference in late events vs. continuation.
Why the study?
Although dual antiplatelet therapy after flow diverter implantation has been widely studied, the optimal duration of subsequent single antiplatelet therapy remains unclear.
Does discontinuation of single antiplatelet therapy at 12 months prevent late ischemic and hemorrhagic events compared to continuation beyond 12 months in patients who underwent flow diverter implantation?
Cohort (n=218)
No
Does discontinuation of single antiplatelet therapy at 12 months prevent late ischemic and hemorrhagic events compared to continuation beyond 12 months in patients who underwent flow diverter implantation?
Discontinuing aspirin monotherapy at 12 months after flow diverter implantation did not increase late ischemic events or affect aneurysm occlusion compared to prolonged therapy, while potentially reducing late hemorrhagic events.
Answers are grounded in this paper and cite their sources.
Stopping single antiplatelet therapy at 12 months was not associated with more late ischemic events after flow diversion; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Although dual antiplatelet therapy (DAPT) after flow diverter (FD) implantation has been widely studied, the optimal duration of subsequent single antiplatelet therapy (SAPT) remains unclear. This study compared late clinical outcomes associated with SAPT discontinuation at 12 months versus continuation beyond 12 months after flow diversion. METHODS: This single-center retrospective study included 218 patients who underwent FD implantation between January 2022 and May 2024. After standard 3-month DAPT, patients transitioned to aspirin monotherapy and were stratified into 1-year or >1-year SAPT cohorts. The primary endpoint was a composite of late ischemic and hemorrhagic events occurring >1 year after the procedure. Secondary endpoints included individual late ischemic and hemorrhagic events and aneurysm occlusion. RESULTS: Median follow-up was 953 days (interquartile range [IQR], 818-1,343 days). Eight late ischemic or hemorrhagic events occurred. Kaplan-Meier analysis showed no significant difference in the primary endpoint between cohorts (weighted log-rank P = 0.152). All late hemorrhagic events (n = 5), including one severe intracerebral hemorrhage, occurred exclusively in the >1-year SAPT cohort. Aneurysm occlusion rates were similar between cohorts. CONCLUSIONS: Compared with prolonged regimens, SAPT discontinuation at 12 months was not associated with an evident increase in late ischemic events or aneurysm remnants, with a potential reduction in late bleeding risk. Patients may not benefit from extending single antiplatelet therapy beyond 1 year after flow diversion. These findings warrant further evaluation in larger prospective studies.
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Liang et al. (2026) conducted a cohort in Intracranial aneurysm treated with flow diverter implantation (n=218). Single antiplatelet therapy (aspirin) discontinuation at 12 months vs. Single antiplatelet therapy continuation beyond 12 months (>1-year SAPT) was evaluated on Composite of late ischemic and hemorrhagic events occurring >1 year after the procedure (p=0.152). SAPT discontinuation at 12 months after flow diversion showed no significant difference in late ischemic or hemorrhagic events versus continuation beyond 12 months.
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