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Roles of light transmission aggregometry and CYP2C19 genotype in predicting ischaemic complications during
Yangyang Zhou1, Wenqiang Li1,2, Chao Wang1
1Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China.
Insights
Maximum platelet aggregation (ADP-MPA) predicts ischemic events during intracranial aneurysm treatment, unlike CYP2C19 genotype. Patients with flow diverters need stronger antiplatelet therapy.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Clopidogrel's antiplatelet effects are crucial for intracranial aneurysm treatment.
- Light transmission aggregometry (LTA) and CYP2C19 genotype analysis are common assessment methods.
Purpose of the Study:
- To determine if LTA or CYP2C19 genotype better predicts ischemic events during endovascular treatment of intracranial aneurysms.
- To identify clinical risk factors for ischemic complications.
Main Methods:
- Compared LTA and CYP2C19 genotype results in 379 patients undergoing intracranial aneurysm treatment.
- Used multivariate regression and ROC curve analysis to assess predictive values for ischemic events.
- Conducted subgroup analyses for CYP2C19 metabolizer status and stent types (flow diverters vs. traditional stents).
Main Results:
- Maximum platelet aggregation induced by ADP (ADP-MPA) predicted ischemic events (AUC=0.752), with a cut-off of 41.5%.
- ADP-MPA and hypertension duration >10 years were independent risk factors; CYP2C19 genotype was not associated with events.
- ADP-MPA predicted events in fast and intermediate CYP2C19 metabolizers, with lower cut-offs for flow diverters (36.4%) than traditional stents (42.9%).
Conclusions:
- ADP-MPA is a reliable predictor of ischemic complications in endovascular treatment of intracranial aneurysms.
- Patients treated with flow diverters require more potent antiplatelet therapy compared to those with traditional stents.
Background And Purpose:
Light transmission aggregometry (LTA) and CYP2C19 genotype analysis are commonly used to evaluate the antiplatelet effects of clopidogrel during the interventional treatment of intracranial aneurysms. The aim of this study was to determine which test can predict ischaemic events during these treatments.
Methods:
Patient demographic information, imaging data, laboratory data and ischaemic complications were recorded. LTA and CYP2C19 genotype results were compared, and multiple linear regression was performed to examine factors related to platelet reactivity. Multivariate regression analysis was performed to determine whether LTA and CYP2C19 could predict ischaemic complications and to identify other clinical risk factors. Receiver operating characteristic curve analysis was conducted to calculate the cut-off value for predicting ischaemic complications. A subgroup analysis was also performed for different CYP2C19 genotype metabolisers, as well as for patients with flow diverters and traditional stents.
Results:
A total of 379 patients were included, of which 22 developed ischaemic events. Maximum platelet aggregation induced by ADP (ADP-MPA) could predict ischaemic events (p<0.001; area under the curve, 0.752 (95% CI 0.663 to 0.842)), and its cut-off value was 41.5%. ADP-MPA (p=0.001) and hypertension duration >10 years (p=0.022) were independent risk factors for ischaemic events, while the CYP2C19 genotype was not associated with ischaemic events. In the subgroup analysis, ADP-MPA could predict ischaemic events in fast metabolisers (p=0.004) and intermediate metabolisers (p=0.003). The cut-off value for ischaemic events was lower in patients with flow diverters (ADP-MPA=36.4%) than in patients with traditional stents (ADP-MPA=42.9%).
Conclusions:
ADP-MPA can predict ischaemic complications during endovascular treatment of intracranial aneurysms. Patients with flow diverters require stronger antiplatelet medication than patients with traditional stents.
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