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

Abstract

Background Dual antiplatelet therapy (DAPT) is necessary for stent assisted coiling. However, long term use of DAPT has a potential risk of hemorrhagic events. We aimed to examine the relationship between clopidogrel reactivity and complications. Methods Patients who underwent stent assisted coiling for unruptured aneurysms or previously treated aneurysms and received periprocedural DAPT in our institution between August 2011 to March 2020 were included. Platelet reactivity for clopidogrel was measured by VerifyNow assay system, and we defined the cut off value of P2Y12 Reaction Units (PRU) at 208 and classified patients as hypo-responders (PRU≧208) or responders (PRU<208). The rates of hemorrhagic and thrombotic events within 30 days (acute phase) and 30 days after the procedure (delayed phase) were compared between the two groups. Furthermore, changes in hemoglobin levels were measured before and after the procedure and at chronic stages (1 to 6 months thereafter). Results From 61 patients included in this study, 36 patients were hypo-responders and 25 patients were responders. Hemorrhagic events occurred 8.0% only in responders in the acute phase (p = 0.16), and 2.78% in hypo-responders and 20.0% in responders in the delayed phase (p = 0.037). Changes in hemoglobin levels before and after the procedure were 1.22 g/dl in hypo-responders and 1.74 g/dl in responders (p = 0.032) while before the procedure and chronic stages they were 0.39 g/dl in hypo-responders and 1.39 g/dl in responders (p < 0.01). Thrombotic events were not significantly different between the two groups. Conclusion Long term use of DAPT after stent assisted coiling is related to hemorrhagic events in the delayed phase. Preventing for hemorrhagic events, the duration of DAPT should be carefully considered in clopidogrel responders.

Perioperative Antiplatelet Therapy for the Stent-Assisted Coil Embolization: Results of the Questionnaire Survey

“…10) Multiple reports have been made on postoperative antiplatelet therapy in the neurointerventional field. 4,[11][12][13][14] These studies have demonstrated the importance of postoperative platelet function tests. Kim et al examined the optimal duration of postoperative DAPT.…”

Update on Clinical Management with Neurovascular Stents

“…It is important to note that the use of SAC in ruptured aneurysms is known to be associated with a greater risk of complications -often attributed to the use of dual antiplatelet therapy -and, according to several authors, should generally be avoided in such populations [47][48][49][50]. In this context, a recent meta-analysis investigating morbidity and mortality in SAC-treated unruptured intracranial aneurysm with wide necks, demonstrated an estimated pooled rate of mortality and overall neurologic complications to be 0.02% and 4.33%, respectively [36].…”

Discontinuation of antiplatelet therapy after stent-assisted coil embolization for cerebral aneurysms

“…12) Although it is common to continue to use DAPT for six weeks to six months, little research has been conducted on the proper length of DAPT use. 2)13)17)18) 20) In addition, few studies have been conducted on MAPT discontinuation. It is a common recommendation to maintain MAPT for the rest of one's life after SACE.…”