Ticagrelor Versus Clopidogrel as Dual Antiplatelet Agents After Flow Diversion With Surface-Modified Stents

BACKGROUND AND OBJECTIVES: Dual antiplatelet therapy (DAPT) is an essential component of medical management after flow diversion. To our knowledge, no studies have compared DAPT regimens using ticagrelor vs clopidogrel in patients undergoing flow diversion with newer generation surface-modified stents. Our study compares outcomes of flow diversion between ticagrelor- and clopidogrel-based DAPT. METHODS: This was a retrospective analysis of patients who underwent flow diversion with surface-modified stents at 6 participating institutions in North America. Patients were dichotomized based on DAPT regimen into acetyl salicylic acid (ASA) + ticagrelor vs ASA + clopidogrel. Outcomes of interest were in-stent stenosis (ISS), stroke or transient ischemic attack (TIA), and hemorrhagic complications on follow-up. RESULTS: Of 171 patients, 48.5% (n = 83) received ticagrelor and 51.4% (n = 88) received clopidogrel. A total of 13.4% patients (n = 23) developed ISS, 6.4% (n = 11) developed stroke/TIA, and 3.5% (n = 6) developed hemorrhagic complications After propensity-score weighting, patients who received clopidogrel did not have higher odds for ISS (odds ratio [OR]: 0.63, 95% CI: 0.25-1.59, P = .333), stroke/TIA (OR: 0.68, 95% CI: 0.19-2.43, P = .555), or hemorrhagic complications (OR: 0.17, 95% CI: 0.02-1.51, P = .113), compared with those receiving ticagrelor. CONCLUSION: DAPT with ASA and ticagrelor demonstrated comparable safety and efficacy to ASA and clopidogrel. Clopidogrel-based DAPT regimens should be considered as first line in preventing ischemic complications. However, in case of clopidogrel resistance, the use of ticagrelor does not confer increased risk of hemorrhagic complications.