Abstract
Introduction
The purpose of this study was to explore the safety and efficacy of an antiplatelet response assay and drug adjustment to prevent delayed thromboembolic events after stent-assisted coil embolization.
Methods
A total of 370 patients were enrolled in this study between December 2005 and July 2014. Of these, 124 patients were placed into the drug resistance test (DRT) group with drug adjustment according to response to an antiplatelet agent, and 246 patients comprised the control group with a standard antiplatelet regimen. The response to the antiplatelet agent was evaluated with the VerifyNow Rapid Platelet Function Assay. Propensity score matching analysis was performed with one-to-multiple matching.
Results
Among 370 patients, delayed thromboembolic events occurred in 28 (7.6 %) patients including 25 (10.2 %) in the control group and three (2.4 %) in the DRT group. Antiplatelet response test (p = 0.012), diabetes mellitus (DM) (p = 0.014), and hypertension (HTN) (p < 0.001) were associated with delayed infarction in multivariate analysis. In propensity score matching analysis, 331 patients were matched (control group (n = 229) vs. DRT group (n = 103)), and antiplatelet response (hazard ratio 0.247, 95 % confidence interval 0.070–0.868, p = 0.029) was correlated with delayed infarction. Conversely, the two groups were not significantly different with regard to total (p = 0.368) or major hemorrhagic complications (p = 0.108).
Conclusion
Antiplatelet drug adjustment according to the results of an antiplatelet response assay might be associated with a decreased risk of delayed thromboembolic infarction compared with the standard antiplatelet regimen.
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References
Akpek S, Arat A, Morsi H, Klucznick RP, Strother CM, Mawad ME (2005) Self-expandable stent-assisted coiling of wide-necked intracranial aneurysms: a single-center experience. AJNR Am J Neuroradiol 26:1223–1231
Galal A, Bahrassa F, Dalfino JC, Boulos AS (2013) Stent-assisted treatment of unruptured and ruptured intracranial aneurysms: clinical and angiographic outcome. Br J Neurosurg 27:607–616
Wanke I, Forsting M (2008) Stents for intracranial wide-necked aneurysms: more than mechanical protection. Neuroradiology 50:991–998
Gentric JC, Biondi A, Piotin M, Mounayer C, Lobotesis K, Bonafe A, Costalat V, French SI (2013) Safety and efficacy of neuroform for treatment of intracranial aneurysms: a prospective, consecutive, French multicentric study. AJNR Am J Neuroradiol 34:1203–1208
Ryu CW, Park S, Shin HS, Koh JS (2015) Complications in stent-assisted endovascular therapy of ruptured intracranial aneurysms and relevance to antiplatelet administration: a systematic review. AJNR Am J Neuroradiol 36:1682–1688
Oxley TJ, Dowling RJ, Mitchell PJ, Davis S, Yan B (2011) Antiplatelet resistance and thromboembolic complications in neurointerventional procedures. Front Neurol 2:83
Mocco J, Fargen KM, Albuquerque FC, Bendok BR, Boulos AS, Carpenter JS, Fiorella DJ, Hoh BL, Howington JU, Liebman KM, Natarajan SK, Rai AT, Rodriguez-Mercado R, Siddiqui AH, Snyder KV, Veznedaroglu E, Hopkins LN, Levy EI (2011) Delayed thrombosis or stenosis following enterprise-assisted stent-coiling: is it safe? Midterm results of the interstate collaboration of enterprise stent coiling. Neurosurgery 69:908–913
Hwang G, Kim JG, Song KS, Lee YJ, Villavicencio JB, Suroto NS, Park NM, Park SJ, Jeong EA, Kwon OK (2014) Delayed ischemic stroke after stent-assisted coil placement in cerebral aneurysm: characteristics and optimal duration of preventative dual antiplatelet therapy. Radiology 273:194–201
Delgado Almandoz JE, Crandall BM, Scholz JM, Fease JL, Anderson RE, Kadkhodayan Y, Tubman DE (2013) Pre-procedure P2Y12 reaction units value predicts perioperative thromboembolic and hemorrhagic complications in patients with cerebral aneurysms treated with the pipeline embolization device. J Neurointerv Surg 5(Suppl 3):iii3–ii10
Maruyama H, Takeda H, Dembo T, Nagoya H, Kato Y, Fukuoka T, Deguchi I, Horiuchi Y, Tanahashi N (2011) Clopidogrel resistance and the effect of combination cilostazol in patients with ischemic stroke or carotid artery stenting using the VerifyNow P2Y12 assay. Intern Med 50:695–698
Ernst M, Yoo AJ, Kriston L, Schonfeld MH, Vettorazzi E, Fiehler J (2015) Is visual evaluation of aneurysm coiling a reliable study end point? Systematic review and meta-analysis. Stroke 46:1574–1581
Ferre JC, Carsin-Nicol B, Morandi X, Carsin M, de Kersaint-Gilly A, Gauvrit JY, Desal HA (2009) Time-of-flight MR angiography at 3 T versus digital subtraction angiography in the imaging follow-up of 51 intracranial aneurysms treated with coils. Eur J Radiol 72:365–369
Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H (2011) Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation 123:2736–2747
Banks JL, Marotta CA (2007) Outcomes validity and reliability of the modified Rankin scale: implications for stroke clinical trials: a literature review and synthesis. Stroke 38:1091–1096
Aradi D, Storey RF, Komocsi A, Trenk D, Gulba D, Kiss RG, Husted S, Bonello L, Sibbing D, Collet JP, Huber K, Working Group on Thrombosis of the European Society of C (2014) Expert position paper on the role of platelet function testing in patients undergoing percutaneous coronary intervention. Eur Heart J 35:209–215
Hwang G, Huh W, Lee JS, Villavicencio JB, Villamor RB Jr, Ahn SY, Kim J, Chang JY, Park SJ, Park NM, Jeong EA, Kwon OK (2015) Standard vs modified antiplatelet preparation for preventing thromboembolic events in patients with high on-treatment platelet reactivity undergoing coil embolization for an unruptured intracranial aneurysm: a randomized clinical trial. JAMA Neurol 72:764–772
Levy EI, Boulos AS, Bendok BR, Kim SH, Qureshi AI, Guterman LR, Hopkins LN (2002) Brainstem infarction after delayed thrombosis of a stented vertebral artery fusiform aneurysm: case report. Neurosurgery 51:1280–1284 discussion 1284-1285
Meschia JF, Bushnell C, Boden-Albala B, Braun LT, Bravata DM, Chaturvedi S, Creager MA, Eckel RH, Elkind MS, Fornage M, Goldstein LB, Greenberg SM, Horvath SE, Iadecola C, Jauch EC, Moore WS, Wilson JA, American Heart Association Stroke C, Council on C, Stroke N, Council on Clinical C, Council on Functional G, Translational B, Council on H (2014) Guidelines for the primary prevention of stroke: a statement for healthcare professionals from the American Heart Association/American Stroke Association. Stroke 45:3754–3832
Rossen JD, Chalouhi N, Wassef SN, Thomas J, Abel TJ, Jabbour PM, Kung DK, Hasan DM (2012) Incidence of cerebral ischemic events after discontinuation of clopidogrel in patients with intracranial aneurysms treated with stent-assisted techniques. J Neurosurg 117:929–933
Goh C, Churilov L, Mitchell P, Dowling R, Yan B (2013) Clopidogrel hyper-response and bleeding risk in neurointerventional procedures. AJNR Am J Neuroradiol 34:721–726
Brinjikji W, Lanzino G, Cloft HJ, Siddiqui AH, Hanel RA, Kallmes DF (2015) Platelet testing is associated with worse clinical outcomes for patients treated with the pipeline embolization device. AJNR Am J Neuroradiol 36:2090–2095
Wiviott SD, Braunwald E, McCabe CH, Horvath I, Keltai M, Herrman JP, Van de Werf F, Downey WE, Scirica BM, Murphy SA, Antman EM, Investigators T-T (2008) Intensive oral antiplatelet therapy for reduction of ischaemic events including stent thrombosis in patients with acute coronary syndromes treated with percutaneous coronary intervention and stenting in the TRITON-TIMI 38 trial: a subanalysis of a randomised trial. Lancet 371:1353–1363
Hashiguchi M, Ohno K, Nakazawa R, Kishino S, Mochizuki M, Shiga T (2004) Comparison of cilostazol and ticlopidine for one-month effectiveness and safety after elective coronary stenting. Cardiovasc Drugs Ther 18:211–217
Montalescot G, Wiviott SD, Braunwald E, Murphy SA, Gibson CM, McCabe CH, Antman EM (2009) Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 373:723–731
Saraf S, Bensalha I, Gorog DA (2009) Antiplatelet resistance-does it exist and how to measure it? Clin Med Cardiol 3:77–91
Hasan MS, Basri HB, Hin LP, Stanslas J (2013) Genetic polymorphisms and drug interactions leading to clopidogrel resistance: why the Asian population requires special attention. Int J Neurosci 123:143–154
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We declare that this manuscript does not contain clinical studies or patient data. The Samsung Medical Center Institutional Review Board waived consent for this retrospective study.
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Kim, M.S., Jo, K.I., Yeon, J.Y. et al. Safety and efficacy of antiplatelet response assay and drug adjustment in coil embolization: a propensity score analysis. Neuroradiology 58, 1125–1134 (2016). https://doi.org/10.1007/s00234-016-1742-6
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DOI: https://doi.org/10.1007/s00234-016-1742-6