Abstract Details

Title Dual Antiplatelet Therapy with Aspirin and Clopidogrel Versus Aspirin and Ticagrelor for Cerebral Endovascular Procedures: A Propensity Score Matching Retrospective Cohort Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S44 - Evidence-based Stroke Interventions and Prognostic Tools (2:00 PM-2:12 PM)

Poster/Presentation
Number 006

Objective To assess and compare the safety and efficacy outcomes of ticagrelor- versus clopidogrel-based dual antiplatelet therapy in patients undergoing cerebral endovascular procedures using a large, real-world, propensity score–matched cohort.

Background Dual antiplatelet therapy (DAPT) is routinely prescribed for patients undergoing neuroendovascular procedures to minimize thromboembolic complications. While clopidogrel remains the standard agent, ticagrelor has emerged as an alternative, particularly for patients with clopidogrel resistance. However, comparative evidence on their clinical outcomes in neurointervention remains limited.

Design/Methods We conducted a retrospective cohort study using de-identified data from 102 U.S. healthcare organizations in the TriNetX Research Network. Adult patients undergoing cerebral endovascular procedures were categorized by DAPT regimen—aspirin plus clopidogrel or aspirin plus ticagrelor. A 1:1 propensity score matching (PSM) was applied to balance baseline demographics, comorbidities, and procedural characteristics. Outcomes, including ischemic stroke, transient ischemic attack (TIA), thrombosis, intracranial hemorrhage (ICH), mortality, and retreatment, were assessed at 30, 90, and 180 days post-procedure.

Results

After PSM, 4,023 patients were included in each group. Ticagrelor-based DAPT was associated with a significantly higher risk of ischemic stroke (RR = 1.210, 95% CI 1.028–1.423) and retreatment (RR = 1.234, 95% CI 1.011–1.506) at 30 days. Thrombosis risk remained consistently higher across all follow-up intervals (RR = 2.042 at 30 days; 1.488 at 90 days; 1.522 at 180 days). No significant differences were observed for TIA, ICH, or mortality at any time point.

Conclusions In this large, multicenter, real-world analysis, ticagrelor-based DAPT was linked to increased early risks of ischemic stroke, thrombosis, and retreatment compared with clopidogrel-based DAPT, without differences in hemorrhagic or mortality outcomes. These findings suggest that ticagrelor may not offer superior clinical protection in neuroendovascular settings and underscore the need for prospective randomized trials to clarify the optimal DAPT regimen for cerebrovascular interventions.

Authors/Disclosures
Davi N. Coelho PRESENTER	Mr. Coelho has nothing to disclose.
Filipi F. Andreão	Mr. Andreão has nothing to disclose.
Filipe V. Ribeiro, MD	Ms. Ribeiro has nothing to disclose.
Arthur Vinicius Cirqueira Marinho, arthurmarinho123@hotmailcom	Mr. Cirqueira Marinho has nothing to disclose.
Paulo Otávio N. Sousa	Mr. Sousa has nothing to disclose.
Mariana Letícia d. Maximiano, MD	Dr. Maximiano has nothing to disclose.
Wander L. Valentim, MD	Dr. Valentim has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Brain4Care.
Savio Batista, MD (Emory University)	Mr. Batista has nothing to disclose.
Diogo Haddad Santos, MD (Moema)	Dr. Haddad Santos has nothing to disclose.

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