Symptomatic thromboembolic events are the most common complications associated with aneurysm coiling, and carotid and intracranial stenting. Our objective is to assess the effect of aspirin (ASA) and clopidogrel dose and duration on platelet inhibition using a point of care assay in neurointerventional (NI) suite.
The dose, duration, and point of care platelet function assay data for clopidogrel and aspirin therapy were prospectively collected between February 2006 and November 2007. Inadequate platelet inhibition for ASA was defined as >or=550 ASA reaction units (ARU), and for clopidogrel was defined as <or=50% inhibition of the P2Y12/ADP receptor
We collected data from 216 consecutive patients. Inadequate platelet inhibition was noted in 13% of patients on aspirin and 66% of patients on clopidogrel (P-value < .0001). Patients taking clopidogrel 75 mg for >or=7 days, 300 mg for 24 hours, and 600 mg same day load had a mean P2Y12/ADP inhibition of 45%, 35% (P-value = .09), and 16%, respectively (P-value = .005).
Premedication with clopidogrel, in contrast to aspirin, does not achieve adequate platelet inhibition in about two-third of the patients. Same day antiplatelet loading may be insufficient to achieve adequate platelet inhibition and should be avoided if clinically feasible.
"Thromboembolic complications are also more frequent in the stented patients (70). Antiplatelet activity assessment prior to stent delivery allows diminishing the occurrence of such complications by identifying the patients not responding to antiplatelet drugs (71, 72). In a recent review article, Shapiro et al. reported an overall complication incidence of 19%, with an overall death incidence of 2.1%. "
[Show abstract][Hide abstract] ABSTRACT: Wide-neck intracranial aneurysms were originally thought to be either untreatable or very challenging to treat by endovascular means because of the risk of coil protrusion into the parent vessel. The introduction of the balloon remodeling technique (BRT) and later stents specifically designed for intracranial use has progressively allowed these lesions to be endovascularly treated. BRT and stent-assisted coiling technique (SACT) were first designed to treat sidewall aneurysms but, with gained experience and further technical refinement, bifurcation complex-shaped wide-neck aneurysms have been treated by coiling enhanced by BRT and SACT. In this article, we will review and describe the inherent benefits and drawbacks of BRT as well as SACT.
Frontiers in Neurology 04/2014; 5:41. DOI:10.3389/fneur.2014.00041
"Pandya et al. (2010) recently reported the largest prospective trial to evaluate pre-procedure dosing regimens and antiplatelet resistance in neurointerventional procedures. Data was collected from 216 consecutive patients including all neurointerventional procedures. "
[Show abstract][Hide abstract] ABSTRACT: Antiplatelet resistance is emerging as a significant factor in effective secondary stroke prevention. Prevalence of aspirin and clopidogrel resistance is dependent upon laboratory test and remains contentious. Large studies in cardiovascular disease populations have demonstrated worse ischemic outcomes in patients with antiplatelet resistance, particularly in patients with coronary stents. Thromboembolism is a complication of neurointerventional procedures that leads to stroke. Stroke rates related to aneurysm coiling range from 2 to 10% and may be higher when considering silent ischemia. Stroke associated with carotid stenting is a major cause of morbidity. Antiplatelet use in the periprocedure setting varies among different centers. No guidelines exist for use of antiplatelet regimens in neurointerventional procedures. Incidence of stroke in patients post procedure may be partly explained by resistance to antiplatelet agents. Further research is required to establish the incidence of stroke in patients with antiplatelet resistance undergoing neurointerventional procedures.
Frontiers in Neurology 12/2011; 2:83. DOI:10.3389/fneur.2011.00083
[Show abstract][Hide abstract] ABSTRACT: Worldwide, intracranial atherosclerosis is the most common cause of ischemic stroke and is associated with a high risk of recurrence. Endovascular therapies including angioplasty and stent implantation may help in secondary stroke prevention due to intracranial stenosis, however rigorous appraisal of clinical efficacy is currently lacking. This review aims to introduce the basic concepts involved with endovascular treatment of intracranial stenosis, its strengths and limitations, and discuss the available data. The importance of patient selection, procedural risks, patient outcomes, and surveillance goals are also highlighted.
The Open Atherosclerosis & Thrombosis Journal 08/2010; 3(1):24-34. DOI:10.2174/1876506801003010024
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