Background and aim: The management of ruptured dissecting cerebral pseudoaneurysms (RDPs) remains a significant neurosurgical challenge. Flow-diversion devices (FDDs) have emerged as an effective therapeutic option; however, their use typically necessitates dual antiplatelet therapy (DAPT), which carries an inherent risk of hemorrhagic complications. This concern has led to growing interest in single antiplatelet therapy (SAPT) with ticagrelor, given its more predictable pharmacodynamic profile. Nevertheless, the evidence supporting the use of ticagrelor-based SAPT in this setting remains limited. This study evaluated the efficacy and safety of single antiplatelet therapy (SAPT) with ticagrelor among patients following flow-diversion treatment for ruptured cerebral pseudoaneurysms (RDPs). Methods: In this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for screening and selecting research articles. Electronic databases used for data extraction were PubMed, ClinicalTrials.gov, and Cochrane Library. The research timeline was set from January 2015 to September 2024. The Newcastle-Ottawa Scale (NOS) was applied to assess the quality of observational studies. This study used the Review Manager (RevMan) software version 5.4 (London, England: Cochrane Collaboration) for pooled analysis. Results: Through a pooled analysis of six cohort or observational studies involving 1118 patients, the findings indicate that single antiplatelet therapy (SAPT) with ticagrelor may be comparable to standard dual antiplatelet therapy in managing thrombosis risk. The pooled analysis showed that the composite outcome of thromboembolic events, major hemorrhagic complications (OR: 0.86, 95% CI: 0.53-1.38), and hemorrhagic complications alone (OR: 0.58, 95% CI: 0.21-1.62) were not significantly different between patients receiving single antiplatelet therapy (SAPT) with ticagrelor and those receiving control antiplatelet regimens (including aspirin and clopidogrel), although the point estimates favored ticagrelor-based SAPT. Similarly, no statistically significant differences were observed in thromboembolic events (OR: 1.15, 95% CI: 0.57-2.32) or mortality (RR: 1.17, 95% CI: 0.21-6.39) between the treatment and control groups. Conclusion: Overall, this meta-analysis suggests that single antiplatelet therapy (SAPT) with ticagrelor may be a feasible and potentially safe alternative to dual antiplatelet therapy in patients undergoing flow-diverter treatment for ruptured dissecting cerebral pseudoaneurysms (RDPs). The available evidence indicates comparable safety profiles, although the certainty of these findings remains limited. Therefore, well-designed randomized controlled trials and prospective comparative studies are warranted to more definitively evaluate efficacy, safety, and optimal patient selection.
Alqahtani et al. (Sun,) studied this question.