Join Prof. Laurent PIEROT at LINNC Paris 2021 as he introduces the novel COATING trial looking at a new type of flow diverter. This flow diverter, with its coated surface, could reduce platelet aggregation, potentially reducing thrombogenic complications and thus reducing the need for dual antiplatelet therapy (DAPT).
The trial is randomized, comparing a classic follow diverter using DAPT to the new, coated flow diverter using single antiplatelet therapy. The endpoint is not clinical, but with an innovative design. It uses DWI MRI to depict small ischemic events, comparing the rate of these ischemic events in both arms of the study - an adaptive design from non-inferiority to superiority.
Interventional neuroradiological has witnessed an evolution in the treatment of aneurysms from coiling to balloon assisted coiling, stent assisted coiling to flow diversion; and while flow diversion is accepted as a highly efficacious approach, it remains limited to unruptured aneurysms due to bleeding risk. But, as Prof. PIEROT explains, if these new coated flow diverters can be used with a single antiplatelet regimen, their use could be extended beyond unruptured aneurysms to include patients with ruptured aneurysms or at higher bleeding risk.
Will this new approach work? Will it change the way we practice?
The challenges of DAPT are numerous. Reducing the risk of hemorrhagic complications in aneurysm treatment is critical.
Inclusion in the COATING trial is starting – more countries are coming on board – stay tuned next year for further information – and LINNC 2024 for the results!