{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,12]],"date-time":"2026-11-12T08:38:02Z","timestamp":1794472682194,"version":"4.9.1"},"reference-count":19,"publisher":"BMJ","issue":"10","funder":[{"name":"wallaby-phenox","award":["N\/A"],"award-info":[{"award-number":["N\/A"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J NeuroIntervent Surg"],"accepted":{"date-parts":[[2025,9,18]]},"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:sec>\n                    <jats:title>Background and purpose<\/jats:title>\n                    <jats:p>Flow diverters (FDs) have become one of the primary treatments for intracranial aneurysms (IAs). However, their use in distal IA has been associated with higher complication rates compared with other techniques. The development of coated FDs, in combination with novel antiplatelet regimens, offers promising strategies to improve the safety profile of FDs in this context. This trial aimed to compare mono antiplatelet therapy (MAPT) using prasugrel versus dual antiplatelet therapy (DAPT) with aspirin and prasugrel for the treatment of distal IA using the p48 MW HPC FD (WallabyPhenox).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>This was a multicenter, prospective, parallel-group, single-blind, non-inferiority randomized trial. Between February 2021 and February 2025, 140 patients were enrolled. After excluding 11 patients, 129 were included in the final analysis. The primary endpoint was the absence of new neurological deficits, defined as no shift in the modified Rankin Scale (mRS) score. The secondary endpoint was the incidence of any stroke.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>At the 30-day follow-up, 66 patients (98.5%) in the MAPT group and 59 patients (95.2%) in the DAPT group showed no new neurological deficits. With a predefined non-inferiority margin of 5%, the difference of 3.35% confirmed the non-inferiority of MAPT compared with DAPT (p=0.002). The incidence of any stroke was 4\/67 (5.9%) in the MAPT group and 6\/62 (9.6%) in the DAPT group (p=0.431).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Prasugrel monotherapy for the treatment of distal IAs using the p48 MW HPC was non-inferior to DAPT within the first 30 days following treatment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical trial registration<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/ensaiosclinicos.gov.br\/rg\/RBR-3q9zb73\">https:\/\/ensaiosclinicos.gov.br\/rg\/RBR-3q9zb73<\/jats:ext-link>\n                      . UTN code: U1111-1290-2489. Research Ethics Committee of the Hospital das Cl\u00ednicas de Ribeir\u00e3o Preto - Universidade de S\u00e3o Paulo. CAAE number: 29848720.0.1001.5440.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/jnis-2025-024144","type":"journal-article","created":{"date-parts":[[2025,10,21]],"date-time":"2025-10-21T09:35:11Z","timestamp":1761039311000},"page":"2045-2050","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Short-term safety of dual versus single antiplatelet therapy in flow diversion for distal intracranial aneurysms: results from the DART trial"],"prefix":"10.1136","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8979-3283","authenticated-orcid":false,"given":"Luis Henrique","family":"de Castro-Afonso","sequence":"first","affiliation":[{"name":"Interventional Neuroradiology, Universidade de S\u00e3o Paulo Faculdade de Medicina de Ribeir\u00e3o Preto, Ribeir\u00e3o Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Saulo","family":"Villas-Boas","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Universidade de S\u00e3o Paulo Faculdade de Medicina de Ribeir\u00e3o Preto, Ribeir\u00e3o Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Guilherme Seizem","family":"Nakiri","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Universidade de S\u00e3o Paulo Faculdade de Medicina de Ribeir\u00e3o Preto, Ribeir\u00e3o Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gustavo","family":"Andrade","sequence":"additional","affiliation":[{"name":"Department of Endovascular Neurosurgery, Hospital da Restaura\u00e7\u00e3o Governador Paulo Guerra, Recife, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3911-8618","authenticated-orcid":false,"given":"\u00cdtalo Emmanuel","family":"Lima Ferreira","sequence":"additional","affiliation":[{"name":"Department of Endovascular Neurosurgery, Hospital da Restaura\u00e7\u00e3o Governador Paulo Guerra, Recife, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 La\u00e9rcio J\u00fanior","family":"Silva","sequence":"additional","affiliation":[{"name":"Department of Endovascular Neurosurgery, Hospital da Restaura\u00e7\u00e3o Governador Paulo Guerra, Recife, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric Homero Albuquerque","family":"Paschoal","sequence":"additional","affiliation":[{"name":"Department of Endovascular Neurosurgery, Ophir Loyola Hospital, Bel\u00e9m, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elias Ant\u00f4nio Tanus","family":"Machado","sequence":"additional","affiliation":[{"name":"Department of Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5622-0702","authenticated-orcid":false,"given":"Jose Alberto","family":"Almeida Filho","sequence":"additional","affiliation":[{"name":"Department of Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0123-3280","authenticated-orcid":false,"given":"Cesar Augusto","family":"Ferreira Alves Filho","sequence":"additional","affiliation":[{"name":"Department of Endovascular Neurosurgery, Paulo Niemeyer State Brain Institute, Rio de Janeiro, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ricardo Santos","family":"de Oliveira","sequence":"additional","affiliation":[{"name":"Neurosurgery, Universidade de S\u00e3o Paulo Faculdade de Medicina de Ribeir\u00e3o Preto, Ribeir\u00e3o Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benedicto Oscar","family":"Colli","sequence":"additional","affiliation":[{"name":"Neurosurgery, Universidade de S\u00e3o Paulo Faculdade de Medicina de Ribeir\u00e3o Preto, Ribeir\u00e3o Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6171-669X","authenticated-orcid":false,"given":"Daniel Giansante","family":"Abud","sequence":"additional","affiliation":[{"name":"Interventional Neuroradiology, Universidade de S\u00e3o Paulo Faculdade de Medicina de Ribeir\u00e3o Preto, Ribeir\u00e3o Preto, Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,10,21]]},"reference":[{"key":"2026091402151532000_18.10.2045.1","doi-asserted-by":"crossref","DOI":"10.3171\/2017.3.FOCUS16450","article-title":"Complications associated with the use of flow-diverting devices for cerebral aneurysms: a systematic review 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