Long-term complications after stent assist coiling dependent on clopidogrel response

Area of Science:

• Neurosurgery
• Interventional Neuroradiology
• Cardiology

Background:

• Dual antiplatelet therapy (DAPT) is essential for stent-assisted coiling procedures.
• Long-term DAPT use carries a risk of hemorrhagic complications.
• Understanding clopidogrel reactivity is key to managing these risks.

Purpose of the Study:

• To investigate the relationship between clopidogrel reactivity and post-procedure complications.
• To compare hemorrhagic and thrombotic event rates in patients with different clopidogrel response levels.
• To assess the impact of clopidogrel response on hemoglobin levels post-procedure.

Main Methods:

• Retrospective analysis of 61 patients undergoing stent-assisted coiling with DAPT.
• Clopidogrel reactivity assessed using VerifyNow assay, defining hypo-responders (PRU≥208) and responders (PRU<208).
• Comparison of acute (≤30 days) and delayed (>30 days) hemorrhagic/thrombotic events and hemoglobin changes.

Main Results:

• Hemorrhagic events occurred more frequently in responders during the delayed phase (20.0% vs. 2.78%, p=0.037).
• Significant hemoglobin drops were observed in responders compared to hypo-responders in both acute and chronic phases.
• No significant difference in thrombotic events was found between the groups.

Conclusions:

• Long-term DAPT following stent-assisted coiling is associated with delayed hemorrhagic events.
• Clopidogrel responders are at higher risk for these delayed hemorrhagic events.
• DAPT duration requires careful consideration in clopidogrel responders to mitigate hemorrhagic risks.