Tailored antiplatelet agent medication in clopidogrel hyporesponsive patients before stent-assisted coiling: single-center experience

Kurniawan, Ricky Gusanto; Song, Yunsun; Kwon, Boseong; Ahn, Yura; Suh, Dae Chul

doi:10.1007/s00234-020-02496-8

Cited by 8 publications

(6 citation statements)

References 26 publications

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“…The procedures were performed under general anesthesia for 902 aneurysms (94.4%), and sedative anesthesia for 54 aneurysms (5.6%). The procedural details have been described previously [ 4 5 8 9 10 11 12 13 14 ]. The femoral approach (n = 954 aneurysms) was routinely used, while the radial approach (n = 2 aneurysms) was used in selected patients.…”

Section: Methodsmentioning

confidence: 99%

Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

et al. 2022

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Objective This study aimed to assess the outcomes of outpatient day-care management of unruptured intracranial aneurysm (UIA), and to present the risks associated with different management strategies by comparing the outcomes and adverse events between outpatient day-care management and management with longer admission periods. Materials and Methods This retrospective cohort study used prospectively registered data and was approved by a local institutional review board. We enrolled 956 UIAs from 811 consecutive patients (mean age ± standard deviation, 57 ± 10.7 years; male:female = 247:564) from 2017 to 2020. We compared the outcomes after embolization among the different admission-length groups (1, 2, and ≥ 3 days). The outcomes included pre- and post-modified Rankin Scale (mRS) scores and rates of adverse events, cure, recurrence, and reprocedure. Events were defined as any cerebrovascular problems, including minor and major stroke, death, or hemorrhage. Results The mean admission period was 2 days, and 175 patients (191 aneurysms), 551 patients (664 aneurysms), and 85 patients (101 aneurysms) were discharged on the day of the procedure, day 2, and day 3 or later, respectively. During the mean 17-month follow-up period (range 6–53 months; 2757 patient years), no change in post-mRS was observed compared to pre-mRS in 99.6% of patients. Cure was achieved in 95.6% patients; minimal recurrence that did not require re-procedure occurred in 3.5% patients, and re-procedure was required in 2.3% (22 of 956) patients due to progressive enlargement of the recurrent sac during follow up (mean 17 months, range, 6–53 months). There were eight adverse events (0.8%), including five cerebrovascular (two major stroke, two minor strokes and one transient ischemic stroke), and three non-cerebrovascular events. Statistical comparison between groups with different admission lengths (1, 2, and ≥ 3 days) revealed no difference in the outcomes. Conclusion This study revealed no difference in outcomes and adverse events according to the admission period, and suggested that UIA could be managed by outpatient day-care embolization.

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Section: Methodsmentioning

confidence: 99%

Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

et al. 2022

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“…If the P2Y12 reaction unit value indicated that the patient was resistant to clopidogrel, tailored medication with low-dose prasugrel was used instead. [18][19][20] During the procedure, each patient received 70 IU/kg of intravenous heparin to attain an activated clotting time of approximately 250-300 seconds, as previously described. Additional heparin at 1,000 IU per hour was administered to maintain the activated clotting time.…”

Section: Methodsmentioning

confidence: 99%

“…All patients were pretreated with 100-mg aspirin and 75-mg clopidogrel daily for 5 days before the procedure. If the P2Y12 reaction unit value indicated that the patient was resistant to clopidogrel, tailored medication with low-dose prasugrel was used instead [ 18 - 20 ]. During the procedure, each patient received 70 IU/kg of intravenous heparin to attain an activated clotting time of approximately 250–300 seconds, as previously described.…”

Section: Methodsmentioning

confidence: 99%

Physiologic Flow Diversion Coiling Technique for Wide-Necked Aneurysms with an Asymmetric Bidirectional Flow at the Aneurysm Neck

et al. 2022

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Purpose: Wide-necked aneurysms in the circle of Willis (CoW) are prone to recur due to reciprocal bidirectional flow. We present a novel concept of coil embolization to prevent recurrence that uses physiologic flow diversion at the CoW.Materials and Methods: We enrolled 14 patients (15 aneurysms) who underwent aneurysm coiling for wide-necked aneurysms with asymmetric bidirectional inflow into the aneurysm. Four patients had recurrent aneurysms after coiling. The concept of physiologic flow diversion included obliterating antegrade flow into the aneurysm sac as well as opposite CoW flow by performing compact coil packing with intentional protrusion out of the aneurysm neck to the communicating part.Results: Fifteen aneurysms, including 4 recurrent aneurysms, in an anterior communicating artery (n=7), posterior communicating artery (n=5), and tip of the basilar artery (n=3) were treated with coil embolization (n=10) and stent-assisted coiling (n=5). All aneurysms had a wide neck, and the mean largest diameter was 9.0 mm. The mean packing density was 45.1%. Twelve aneurysms were completely occluded, and 3 aneurysms had tiny residual neck remnants. There was neither a neurological event nor recurrence during the mean 12.5 months of follow-up.Conclusion: Wide-necked aneurysms at the CoW tend to recur. As a strategy to prevent a recurrence, physiologic flow diversion can be an option in treating wide-necked aneurysms in the CoW.

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“…If the P2Y12 reaction units value indicated that the patient was resistant to clopidogrel, tailored medication with low-dose prasugrel was used instead. [23][24][25] During the procedure, each patient received 70 IU/kg of intravenous heparin to attain an activated clotting time of approximately 250-300 seconds. Additional heparin at 1,000 IU per hour was administered to maintain the activated clotting time.…”

Section: Methodsmentioning

confidence: 99%

Microcatheter Stabilization Technique Using Partially Inflated Balloon for Coil Embolization of Paraclinoid Aneurysms

et al. 2021

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Purpose: Coil embolization of paraclinoid aneurysms should be simple, safe, and effective considering the benign nature of the aneurysm. Here, we present a microcatheter stabilization technique using a partially inflated balloon for the treatment of paraclinoid aneurysms.Materials and Methods: This retrospective study included 58 patients who underwent balloon-assisted coiling (BAC) for unruptured paraclinoid aneurysms at a tertiary neuro-intervention center between January 2019 and March 2020. We applied a technique to stabilize the microcatheter’s position using the modified BAC technique in paraclinoid aneurysms showing various projections around the ophthalmic curve of the internal carotid artery. The basic concept of the technique is to place a partially inflated balloon just distal to the aneurysm neck and support the distal curve of the microcatheter using the proximal bottom of the balloon. Immediate radiological outcomes were analyzed, and clinical outcomes were evaluated with modified Rankin Scale (mRS) scores.Results: The BAC was successfully performed in 51 of 58 patients (88%). We treated the remaining seven patients by switching to stent-assisted coiling. We obtained a 37% mean packing density resulting in favorable occlusion in all 58 aneurysms (complete occlusion in 35 and residual neck in 23). There were no intraprocedural thromboembolic or hemorrhagic events except one that revealed an asymptomatic infarction after the procedure (1.7%). Magnetic resonance angiography follow-up was performed in 37 patients at an average of 11.8 months, in which 11 minor recurrences (29.7%) were found. There was no major recurrence nor retreatment. The mRS score was 0 in all patients during a mean follow-up of 17.7 months (range, 12–25 months).Conclusion: The modified balloon-assisted coiling technique using a partially inflated balloon was safe and effective and could serve as an option for treating paraclinoid aneurysms.

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Tailored antiplatelet agent medication in clopidogrel hyporesponsive patients before stent-assisted coiling: single-center experience

Cited by 8 publications

References 26 publications

Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

Outpatient Day-Care Management of Unruptured Intracranial Aneurysm: A Retrospective Cohort Study

Physiologic Flow Diversion Coiling Technique for Wide-Necked Aneurysms with an Asymmetric Bidirectional Flow at the Aneurysm Neck

Microcatheter Stabilization Technique Using Partially Inflated Balloon for Coil Embolization of Paraclinoid Aneurysms

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