Insufficient Platelet Inhibition Is Related to Silent Embolic Cerebral Infarctions After Coronary Angiography

Abstract

Background and Purpose-Considering that insufficient platelet inhibition is related to thrombotic complications after coronary angiography, we hypothesized that the extent of platelet inhibition by antiplatelet agents is related to the occurrence of silent embolic cerebral infarction (SECI) after coronary angiography. Methods-Among the patients scheduled for coronary artery bypass surgery, we retrospectively analyzed the location of SECI on diffusion-weighted imaging of 272 patients, which was performed after coronary angiography, as a presurgical evaluation in Phase 1 study. In Phase 2 study, we have prospectively recruited 102 patients to compare the extent of platelet inhibition measured by the VerifyNow system among patients with and without SECI. Results-SECI is observed in 45 patients (16.5%) in Phase 1 and 17 (16.7%) in Phase 2. The lesions were slightly more frequent in the right hemisphere. In the Phase 2 study, aspirin reaction units and P 2 Y 12 reaction units were higher in the patients with SECI than those without (aspirin reaction units: 490Ϯ72 versus 446Ϯ53, Pϭ0.03; P 2 Y 12 reaction units: 352Ϯ65 versus 300Ϯ77, Pϭ0.009). The incidence of SECI increased with the number of resistant antiplatelets; resistance to both antiplatelet agent (50%), resistance to 1 antiplatelet agent (22%), and no resistance (4%; Pϭ0.023).From the result of logistic regression, higher aspirin reaction units, white blood cell count, low hemoglobin, and nonresponsiveness to antiplatelet agents were independent risk factors. Conclusions-Insufficient platelet inhibition after administration of antiplatelet agents is related with SECI appearing after coronary angiography. (Stroke. 2012;43:727-732.)

Incidence and Predictors of Catheterization-Related Cerebral Infarction on Diffusion-Weighted Magnetic Resonance Imaging

“…Previous studies using DW MRI have reported that possible risk factors are related to atherosclerotic burden and mechanical stress, including hypertension [ 12 ], history of vasculopathy [ 7 ], number of catheters used [ 7 ], fluoroscopy time [ 7 , 9 , 10 ], amount of contrast medium [ 7 ], performing internal mammary artery angiography [ 13 ], and retrograde passage of the aortic valve [ 8 ]. Previous studies using DW MRI found no association between lipid profile and catheterization-related CI [ 7 – 14 ]. Despite the fact that the development of atherosclerotic CAD is associated with LDL, TG, and HDL levels [ 27 ], as well as the total level of cholesterol [ 27 , 28 ], to the best of our knowledge, lipid profile has not been found to have a significant effect on the incidence of CI after catheterization [ 1 , 6 , 12 ].…”

Clopidogrel Resistance in Patients With Stroke Recurrence Under Single or Dual Antiplatelet Treatment

“…Because of the high prevalence of the CYP 2C19 variant in Korea, a PRU higher than 275 was predictive of clinical events. Therefore, in this study, a PRU higher than 275 was considered indicative of clopidogrel resistance ( 10 – 13 ).…”

Antiplatelet testing in neurointervention: we cannot ignore the signs

“…This harm has been well documented in the cardiology literature, with a global relative risk of recurrent ischemic events of 3.5 (p=0.0001) in clopidogrel non-responders 4. This ischemia is not only cardiac; insufficient platelet inhibition is significantly correlated with the presence of cerebral diffusion-weighted imaging changes after coronary angiography 5. Results from working in cerebrovascular beds directly are limited, but emerging data are noteworthy.…”