====== Antiplatelet complications ======

It is known that [[stent-assisted coiling]] (SAC) for ruptured [[wide-neck intracranial aneurysm]]s has a good efficacy; however, there is an increased risk of perioperative hemorrhagic complications due to the
need for [[dual antiplatelet therapy]] (DAPT).
((H. Roh, J. Kim, H. Bae, K. Chong, J.H. Kim, S.I. Suh, T.H. Kwon, W. Yoon,
Comparison of stent-assisted and no-stent coil embolization for safety and effectiveness in the treatment of ruptured intracranial aneurysms, J. Neurosurg.
(2019) 1–7))
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Especially, invasive procedures like [[external ventricular drainage]] (EVD) or [[ventriculoperitoneal shunt]] (VPS), which are inevitable for patients presenting with [[hydrocephalus]], might lead to [[intracerebral hemorrhage]]s (ICH) or [[contusion]]s along the trajectory of the [[catheter]]s. However, abrupt cessation of [[antiplatelet]]s should be avoided, since it might increase the risk of [[thromboembolism]], especially during the acute period after [[stent]] placement
((H. Nishido, M. Piotin, B. Bartolini, S. Pistocchi, H. Redjem, R. Blanc, Analysis of
complications and recurrences of aneurysm coiling with special emphasis on the
stent-assisted technique, AJNR Am. J. Neuroradiol. 35 (2) (2014) 339–344)).
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Balancing the risk of stent-associated thromboembolism and perioperative hemorrhagic events is challenging.
There are no evidence-based guidelines for the management of DAPT in patients who have recently undergone placement of neurovascular stent and require intracranial surgical procedures. Previous retrospective studies suggested that VPS in patients on DAPT might be
associated with an increased risk of ICH; however most of the hemorrhages were asymptomatic

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The effect of the loading dose of antiplatelets prior to the stent coiling procedure in an unsecured [[wide neck]]ed ruptured intracranial aneurysm is not known.

In the series of Lodi et al carefully selected patients, therapeutic dual antiplatelet loading prior to Stent-assisted coiling of ruptured wide necked intracranial aneurysm was not associated with increased bleeding complications. However, thromboembolic events remain the main challenge. Further study is required to confirm the safety of antiplatelet loading in stent assisted ruptured intracranial aneurysm coiling
((Lodi YM, Latorre JG, El-Zammar Z, Swarnkar A, Deshaies E, Fessler RD. Stent
assisted coiling of the ruptured wide necked intracranial aneurysm. J Neurointerv
Surg. 2012 Jul;4(4):281-6. doi: 10.1136/neurintsurg-2011-010035. Epub 2011 Jul
18. PubMed PMID: 21990500.)).