title: Use of aspirin as sole oral antiplatelet therapy in acute flow diversion for ruptured dissecting aneurysms.
abstract: Subarachnoid hemorrhage secondary to rupture of a circumferential dissecting aneurysm continues to be a treatment dilemma. Vessel sacrifice, when possible, continues to be the safest option but in certain cases this is not possible due to lack of collateral supply. In such cases, coil assisted endovascular flow diversion has become a potential option but the requirement for dual antiplatelet therapy in an unsecured intracranial aneurysm continues to raise concern.We present a 48-year-old man with a World Federation of Neurological Surgeons grade 5 subarachnoid hemorrhage, secondary to a ruptured intradural left vertebral artery dissecting aneurysm, who was treated successfully with a pipeline embolization device with Shield technology using aspirin and a single intravenous loading dose of abciximab. To our knowledge, this is the first case of an acute flow diversion performed using only aspirin as the sole oral antiplatelet agent.
authors.affiliation: Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.
authors.forename: Albert Ho Yuen
authors.initials: AH
authors.lastname: Chiu
authors.affiliation: Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.
authors.forename: Rajalakshmi
authors.initials: R
authors.lastname: Ramesh
authors.affiliation: Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia Prince of Wales Clinical School, University of New South Wales, Randwick, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Wenderoth
authors.affiliation: Department of Neurosurgery, St George Hospital, Kogarah, New South Wales, Australia St George and Sutherland Clinical School, University of New South Wales, Kogarah, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Davies
authors.affiliation: Department of Interventional Neuroradiology, Institute of Neurological Sciences, Prince of Wales Hospital and Community Health Services, Randwick, New South Wales, Australia.
authors.forename: Andrew
authors.identifier: http://orcid.org/0000-0003-2815-9198
authors.initials: A
authors.lastname: Cheung
keywords: Aneurysm; Flow Diverter; Hemorrhage; Platelets