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Abrar Arham
National Brain Center Hospital Prof. Dr. dr. Mahar Mardjono, Jakarta, Indonesia
Medicine & Pharmacology Neuroscience

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The Role of Dual Antiplatelet in Stent-Assisted Coiling in Wide-Neck Aneurysm Ricky Gusanto Kurniawan; Bambang Tri Prasetyo; Beny Rilianto; Abrar Arham
AKSONA Vol. 3 No. 1 (2023): JANUARY 2023
Publisher : Universitas Airlangga

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Highlight: Dual antiplatelet is the gold standard for endovascular treatment of wide-neck aneurysms. The role of dual antiplatelet is to prevent stent thrombosis after treatment. The thrombosis rate reported during stent-assisted coiling is quite high.   ABSTRACT Stent-assisted coiling (SAC) in wide-neck aneurysm treatment is associated with antiplatelet use. Dual antiplatelet therapy (DAPT) has been the gold standard for protecting against thrombosis events and is widely accepted for endovascular embolization treatment with a stent-assisted or flow diverter. Some patients experience vascular events due to the reduced efficacy of antiplatelet agents despite taking DAPT. The reported thrombosis rates during stent-assisted coiling embolization range from 2% to 20%. Thromboembolic complications, such as in-stent thrombosis, can manifest in 4.6% of cases. The correlation between platelet reactivity during treatment and bleeding events remains unclear. However, the association between High Residual Platelet Reactivity (HRPR) or hyporesponsiveness and ischemic events is well established. Based on various laboratory definitions, hyperresponsiveness in patients with clopidogrel occurs in about 14–30% of patients due to major and minor bleeding. Therefore, the optimization of antiplatelet therapy has developed significantly in the neurointerventional community.  
Treatment of Wide-Neck Intracranial Aneurysm: Current Concepts and Endovascular Approach Ricky Gusanto Kurniawan; Bambang Tri Prasetyo; Beny Rilianto; Pratiwi Raissa Windiani; Kelvin Theandro Gotama; Abrar Arham
AKSONA Vol. 3 No. 1 (2023): JANUARY 2023
Publisher : Universitas Airlangga

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Highlight: Endovascular treatment is recommended for aneurysms Wide-neck aneurysm is difficult to treat with endovascular approach. Stent-assisted coiling and flow diverter are choices for wide-neck aneurysms   ABSTRACT A wide-neck aneurysm, described as an aneurysm with a neck of 4 mm or a dome-to-neck ratio of <2, requires more advanced endovascular treatment than a narrow-neck aneurysm. Stent-assisted coiling (SAC) was the sole endovascular approach for wide-neck cerebral aneurysms, which were difficult to treat surgically or by embolization. More advanced endovascular approaches have since been developed in recent years, namely the flow diverter (FD) as an endovascular treatment for wide-neck cerebral aneurysms with an endoluminal reconstruction approach. Both techniques have advantages and disadvantages that must be studied further to develop a wide-neck cerebral aneurysm therapy. Therefore, based on the current literature, this article intends to review the differences in the efficacy and complications of SAC and FD for wide-neck aneurysm therapy.  
Co-Authors Bambang Tri Prasetyo Beny Rilianto Kelvin Theandro Gotama Pratiwi Raissa Windiani Ricky Gusanto Kurniawan