Association between CYP2C19 Polymorphisms and Outcomes in Cerebral Endovascular Therapy.

Area of Science:

• Pharmacogenomics
• Neurology
• Cardiovascular Medicine

Background:

• Clopidogrel response varies among patients undergoing endovascular treatment for cerebrovascular diseases, potentially increasing vascular complication risks.
• CYP2C19 gene polymorphisms are known to affect clopidogrel metabolism and efficacy.

Purpose of the Study:

• To investigate the clinical impact of CYP2C19 gene polymorphisms on outcomes in patients receiving endovascular treatment.
• To determine if specific CYP2C19 genotypes are associated with altered clopidogrel response or clinical events.

Main Methods:

• Prospective, longitudinal, observational study including 108 participants.
• Assessed clopidogrel response using the VerifyNow P2Y12 assay and performed CYP2C19 genotyping via PCR-RFLP.
• Collected data on demographics, cerebrovascular status, vascular complications, mortality, and modified Rankin Scale score at 3-month follow-up.

Main Results:

• Participants with the CYP2C19*17 genotype (group 3) showed a significantly higher incidence of ischemic events (32.1%) compared to the wild-type group (11.4%).
• No significant differences in clopidogrel response were observed across the four CYP2C19 genotype groups.
• The increased risk of ischemic events in the CYP2C19*17 group was independent of measured clopidogrel responsiveness.

Conclusions:

• The CYP2C19*17 genotype may be associated with an elevated risk of ischemic events post-endovascular treatment.
• This increased risk appears to be independent of clopidogrel responsiveness, suggesting alternative mechanisms.
• Larger studies are warranted to validate these findings and elucidate the mechanisms driving the increased ischemic risk.