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Related Experiment Videos

Use of Platelet Function Testing Before Pipeline Embolization Device Placement: A Multicenter Cohort Study.

Nimer Adeeb1, Christoph J Griessenauer1, Paul M Foreman1

  • 1From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); and Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.).

Stroke
|April 16, 2017
PubMed
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Platelet function testing is crucial for patients undergoing Pipeline Embolization Device procedures for intracranial aneurysms. Clopidogrel nonresponders face higher risks, but switching to ticagrelor or using a clopidogrel boost mitigates these complications.

Area of Science:

  • Neurointerventional radiology
  • Vascular neurology
  • Interventional cardiology

Background:

  • Thromboembolic complications are a significant risk after neurointerventional procedures.
  • Pipeline Embolization Device (PED) use for intracranial aneurysms requires dual antiplatelet therapy (DAPT).
  • The utility of platelet function testing (PFT) prior to PED placement is debated.

Purpose of the Study:

  • To evaluate the impact of clopidogrel responsiveness on thromboembolic complications after PED placement.
  • To assess strategies for mitigating risks in clopidogrel nonresponders.

Main Methods:

  • Retrospective review of 402 patients undergoing 414 PED procedures for intracranial aneurysms (2009-2016).
  • Analysis of clinical and radiographic data, focusing on thromboembolic events and clopidogrel responsiveness.
Keywords:
aneurysmclopidogrelcomplicationspipeline embolization deviceplatelet function testrespondersthromboembolicticagrelor

Related Experiment Videos

  • Comparison of outcomes based on clopidogrel response, medication adjustments (ticagrelor switch, clopidogrel boost), and hemorrhagic complications.

    • Main Results:

    • Thromboembolic complications occurred in 9.2% of procedures (5.6% symptomatic).
    • Clopidogrel nonresponders had a higher complication rate (17.4%) versus responders (5.6%).
    • Switching nonresponders to ticagrelor (2.7%) or administering a pre-procedure clopidogrel boost (9.8%) significantly reduced complications compared to non-boosted nonresponders (51.9%). No difference in hemorrhagic complications was noted.

    Conclusions:

    • Clopidogrel nonresponsiveness is associated with increased thromboembolic risk post-PED placement.
    • Switching to ticagrelor or using a pre-procedure clopidogrel boost effectively mitigates this risk in nonresponders.
    • Platelet function testing may guide antiplatelet therapy selection to improve outcomes in PED procedures.