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Safety and Efficacy of Low-dose Prasugrel in the Endovascular Treatment of Unruptured Aneurysms in the Elders (≥ 75 Years)

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Abstract

Purpose

The effectiveness and safety of low-dose prasugrel (PSG) premedication for endovascular treatment of unruptured intracranial aneurysms (UIAs) have been widely reported. In this study, we evaluated the clinical outcomes of elders patients (≥ 75 years) treated with PSG.

Methods

A total of 200 patients with 209 UIAs who were administered PSG as premedication (20 mg loading and 5 mg maintenance with 100 mg aspirin) between March 2018 and December 2021 were retrospectively enrolled. Among them, 39 patients were aged 75 years or over (elders group), and 161 patients were aged under 75 years (control group). Patients’ clinical data were collected, and outcomes were compared between the two groups.

Results

Of the 200 patients with PSG, 9 cases (4.5%) had overall complications (7 ischemic, 2 hemorrhagic). In the comparison between the elders group and the control group, no significant differences were observed in the overall complication rates (elders group vs. control group; 2.6% vs. 5.0%, P = 1.00). Moreover, the rates of poor clinical outcome were comparable (2.6% vs. 1.2%, P = 0.48). The subgroup analysis of patients with stent-assisted procedures revealed no significant differences in complication rates (0% vs. 1.6%, P = 1.00) or poor clinical outcomes (0% vs. 0%, P = 1.00) during maintenance with aspirin 100 mg or PSG 5 mg.

Conclusion

The complication rates in the elders treated with low-dose PSG premedication were similar to those in the control. Low-dose PSG premedication could be prescribed without any additional risk for the endovascular treatment of UIAs in elders patients.

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Funding

This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors

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Authors and Affiliations

  1. Department of Neurosurgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, 102, Heukseok-ro, Dongjak-gu, 06973, Seoul, Korea (Republic of)

    Shin Heon Lee, Hyun Ho Choi, Kyoung Min Jang & Taek Kyun Nam

  2. Department of Radiology, Seoul Medical Center, 156, Sinnae-ro, Jungnang-gu, 02053, Seoul, Korea (Republic of)

    Jun Soo Byun

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  1. Shin Heon Lee
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  2. Hyun Ho Choi
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  3. Kyoung Min Jang
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Corresponding author

Correspondence to Hyun Ho Choi.

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Conflict of interest

S.H. Lee, H.H. Choi, K. Min Jang, T. Kyun Nam and J. Soo Byun declare that they have no competing interests.

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Lee, S.H., Choi, H.H., Jang, K.M. et al. Safety and Efficacy of Low-dose Prasugrel in the Endovascular Treatment of Unruptured Aneurysms in the Elders (≥ 75 Years). Clin Neuroradiol 33, 179–186 (2023). https://doi.org/10.1007/s00062-022-01199-2

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  • DOI: https://doi.org/10.1007/s00062-022-01199-2

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