Preinterventional Clopidogrel Response Variability for Coil Embolization of Intracranial Aneurysms: Clinical Implications

Hs, Kang; Kwon, Bum Sun; Kim, J E; Han, Moon Hee

doi:10.3174/ajnr.a2051

Cited by 96 publications

(82 citation statements)

References 35 publications

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“…Kang et al demonstrated that a higher rate of thromboembolic complications in patients with insufficient platelet inhibition, 20 which was similar to our results despite the use of a different endovascular procedure (coil vs stent) and antiplatelet function test (VerifyNow vs TEG). Light transmission aggregometry (LTA) is considered the gold standard in the evaluation of platelet function, but it is costly and time-consuming.…”

Section: Discussionsupporting

confidence: 81%

Insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysms after stent placement

Yang¹,

Li²,

Jiang³

2016

JNS

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C erebral infarction is one of the major disabling complications of neurovascular stent treatment. During the last decades, many studies have evaluated the safety and efficacy of the technique of stent placement for intracranial aneurysms, which demonstrated a range of 3.7%-21% thromboembolic complications. 4,10,11,29 Dual antiplatelet therapy (aspirin and clopidogrel) has been used as the standard protocol to decrease the incidence of thromboembolic complications in patients with intracranial aneurysms undergoing stent treatment. However, many patients still experience thromboembolic complications after neurovascular intervention, despite being compliant with the standard antiplatelet medication protocol.Previous studies have demonstrated that a low response to antiplatelet medication was associated with the abbreviatioNs AA = arachidonic acid; ADP = adenosine diphosphate; DWI = diffusion-weighted imaging; ICA = internal carotid artery; MA = maximum amplitude; mRS = modified Rankin Scale; TEG = thromboelastography. obJective Insufficient platelet inhibition has been associated with an increased incidence of thromboembolic complications in cardiology patients undergoing percutaneous coronary intervention. Data regarding the relationship between insufficient platelet inhibition and thromboembolic complications in patients undergoing neurovascular procedures remain controversial. The purpose of this study was to assess the relationship of insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysm undergoing stent treatment. methods The authors prospectively recruited patients with intracranial aneurysms undergoing stent treatment and maintained the data in a database. MRI with diffusion-weighted sequences was performed within 24 hours of stent insertion to identify acute ischemic lesions. The authors used thromboelastography to assess the degree of platelet inhibition in response to clopidogrel and aspirin. Univariate and multivariate logistic regression analysis was used to identify potential risk factors of thromboembolic complications. results One hundred sixty-eight patients with 193 aneurysms were enrolled in this study. Ninety-one of 168 (54.2%) patients with acute cerebral ischemic lesions were identified by diffusion-weighted MRI. In 9 (5.4%) patients with ischemic lesions, transient ischemic attack or stroke was found at discharge, and these complications were found in 11 (6.5%) patients during the follow-up period. The incidence of periprocedural thromboembolic complications increased with resistance to antiplatelet agents, hypertension, hyperlipidemia, complete occlusion, and aneurysm of the anterior circulation. The multivariate regression analysis demonstrated that the anterior circulation and adenosine diphosphate (ADP) inhibition percentage were independent risk factors of perioperative thromboembolic complications. The maximum amplitude and ADP inhibition percentage were independent risk factors for thromboembolic complications during the follow-up peri...

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Section: Discussionsupporting

confidence: 81%

Insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysms after stent placement

Yang¹,

Li²,

Jiang³

2016

JNS

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“…11,21,22 However, patients in these studies regarding antiplatelet resistance were mostly those with atherosclerotic steno-occlusive disease, especially in cardiointerventions. 23,24 Unlike atherosclerotic vessels, unruptured aneurysms do not always cause significant atherosclerotic burden.…”

Section: Discussionmentioning

confidence: 99%

“…9,10 Still, these results are controversial, and the association between antiplatelet drug resistance and diffusion lesions has not yet been fully elucidated. 11,12 Therefore, the purpose of this study was to verify the association between thromboembolic infarction and antiplatelet drug resistance after endovascular coil embolization for unruptured intracranial aneurysms. We also explored other risk factors for thromboembolic complications.…”

mentioning

confidence: 99%

Association between Postprocedural Infarction and Antiplatelet Drug Resistance after Coiling for Unruptured Intracranial Aneurysms

Ms¹,

Yeon³

et al. 2016

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Procedure-related thromboembolism is a major limitation of coil embolization, but the relationship between thromboembolic infarction and antiplatelet resistance is poorly understood. The purpose of this study was to verify the association between immediate postprocedural thromboembolic infarction and antiplatelet drug resistance after endovascular coil embolization for unruptured intracranial aneurysm.

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“…According to the protocol of our institution, dual antiplatelet agents (clopidogrel and aspirin) were administered when stent protection was anticipated during the procedure. In patients showing poor response to clopidogrel based on the VerifyNow P2Y12 assay (Accumetrics, San Diego, California), 10 cilostazol was added. A bolus of 3000 IU of heparin was administered after femoral artery sheath placement, and intermittent boluses of 1000 IU per hour were then administered.…”

Section: Dsa and Endovascular Proceduresmentioning

confidence: 99%

Stent-Assisted Coil Embolization of Posterior Communicating Artery Aneurysms

Cho¹,

Lee²,

Kim³

et al. 2013

AJNR Am J Neuroradiol

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BACKGROUND AND PURPOSE:Use of protective stents may not be effective in coil embolization of wide-neck aneurysms involving the posterior communicating artery. Successful implementation depends on the caliber of the vessel, its angle of origin, and the manner in which its orifice is incorporated into the aneurysm. Presented here are the results (clinical and radiographic) of coil embolization in aneurysms of the ICA-posterior communicating artery junction, variably aided by stents. The primary focus is angiographic configurations that impact stent placement.

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Preinterventional Clopidogrel Response Variability for Coil Embolization of Intracranial Aneurysms: Clinical Implications

Cited by 96 publications

References 35 publications

Insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysms after stent placement

Insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysms after stent placement

Association between Postprocedural Infarction and Antiplatelet Drug Resistance after Coiling for Unruptured Intracranial Aneurysms

Stent-Assisted Coil Embolization of Posterior Communicating Artery Aneurysms

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