Clinical Outcomes After Clopidogrel Versus Prasugrel Use in Endovascular Treatment of Unruptured Intracranial Aneurysms: A Propensity-Matched TriNetX Analysis

Background Endovascular treatment of unruptured intracranial aneurysms (UIAs) often requires dual antiplatelet therapy with aspirin and a P2Y12 inhibitor. Clopidogrel remains widely used, but variable bioactivation and high on-treatment platelet reactivity have prompted interest in alternatives such as prasugrel. We compared thromboembolic and hemorrhagic outcomes after clopidogrel versus prasugrel use in endovascular UIA treatment. Methods We queried the TriNetX Global Collaborative Network for adults with UIA who underwent endovascular treatment between 2016 and 2025 and received aspirin plu

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