Utility of Antiplatelet Therapy With Ticlopidine in Patients Refractory to Clopidogrel for Intracranial Stenting: A Single Institution Experience

Abstract

Background: The use of antiplatelets in intra-arterial stenting for cerebrovascular disease has been associated with a decrease in morbidity and mortality. Ticlopidine, a thienopyridine that inhibits ADP-mediated platelet aggregation, has been used with aspirin to treat patients with stroke and prevent thromboembolic occlusion in patients who have undergone endovascular procedures. Because of the reported side effects associated with ticlopidine such as bleeding, thrombocytopenic thrombotic purpura and neutropenia, another thienopyridine, clopidogrel, became the agent of choice as an antiplatelet regimen. However, as the literature accumulates, it is becoming evident that many patients are resistant or allergic to clopidogrel, thus highlighting the need for an alternative antiplatelet agent to prevent complications associated with endovascular management.