Safety and efficacy of ticagrelor-based dual antiplatelet therapy in endovascular treatment of unruptured intracranial aneurysms: a large single-center retrospective study

Abstract

Purpose To evaluate the safety and efficacy of ticagrelor-based dual antiplatelet therapy (DUAP) in patients undergoing stent-assisted endovascular treatment (EVT) of unruptured intracranial aneurysms (UIAs) in a large single-center cohort. Methods We retrospectively analyzed 153 patients who underwent elective stent-assisted EVT for UIAs and were exclusively managed with aspirin and ticagrelor from January 2021 to December 2024. Clinical outcomes included thromboembolic events (cTE), hemorrhagic events (HE), disability, and mortality. Follow-up involved cone-beam CT for early hemorrhagic complications, scheduled MRI/MR-A, and digital subtraction angiography (DSA) at six months. Outcomes were compared across treatment types: stent-assisted coil embolization (SACE, laser-cut or braided), Y-stenting, flow diversion (FD), and stent monotherapy. Results Among 153 patients (mean age 54.8 +/- 13.2 years; 75.2% female), thromboembolic events occurred in 4 (2.6%) and hemorrhagic events in 6 (3.9%) cases during a mean follow-up of 22.5 +/- 15.9 months. Permanent disability occurred in 3 patients (2.0%) and mortality in 2 (1.3%). Event rates did not differ significantly among treatment subgroups (p > 0.05). Conclusion Ticagrelor-based DUAP was associated with low thromboembolic and hemorrhagic complication rates in patients undergoing stent-assisted endovascular treatment of unruptured intracranial aneurysms, supporting its safety and efficacy in this setting.