Work

Three-month versus prolonged dual antiplatelet therapy after pipeline flow diversion with shield technology: a multicenter registry analysis

Year: 2026

Type: article

Abstract: 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.

Source: Journal of NeuroInterventional Surgery

DOI: 10.1136/jnis-2026-026093