Guided Antiplatelet Therapy for Stent-Treated Intracranial Aneurysms: A Cluster-Randomized Trial

Area of Science:

• Neurointerventional Surgery
• Cardiology
• Pharmacology

Background:

• Poor antiplatelet drug response during neurointerventions for intracranial aneurysms (IAs) elevates ischemic event (IE) risk.
• Ticagrelor may offer a safer alternative to clopidogrel in managing antiplatelet therapy.
• Standard dual antiplatelet therapy (SDAT) involves aspirin and clopidogrel.

Purpose of the Study:

• To evaluate if platelet function test (PFT)-guided antiplatelet therapy reduces IE incidence compared to SDAT in IA patients.
• To assess the efficacy and safety of PFT-guided therapy in neurointerventional procedures.

Main Methods:

• A prospective, multicenter, cluster-randomized trial involving 16 neurointerventional teams.
• Test group: PFT-guided therapy with dose adjustment or switch to ticagrelor for poor responders.
• Control group: SDAT. Primary outcome: cerebral IE within 30 days.

Main Results:

• Lower IE incidence in the PFT-guided group (6.8%) vs. SDAT group (13.2%) within 30 days (OR, 0.54; P=.03).
• Reduced IE incidence within 7 days (4.1% vs. 10.8%; OR, 0.48; P=.02).
• No significant difference in modified Rankin Scale scores or all-cause mortality; bleeding event incidence was similar between groups.

Conclusions:

• PFT-guided antiplatelet therapy is associated with a reduced incidence of ischemic events in patients undergoing endovascular treatment for IAs.
• Switching to ticagrelor as part of PFT-guided therapy did not increase the risk of bleeding events.