The utility of platelet inhibition testing in patients undergoing Pipeline embolization of intracranial aneurysms

2021 ◽  
pp. neurintsurg-2021-017681
Author(s):  
Timothy R Miller ◽  
Aaron Wessell ◽  
Gaurav Jindal ◽  
Ajay Malhotra ◽  
J Marc Simard ◽  
...  
Keyword(s):  
Platelet Aggregation ◽  
Treatment Outcomes ◽  
Intracranial Aneurysms ◽  
Platelet Inhibition ◽  
Dose Titration ◽  
Inhibition Assay ◽  
Aggressive Management ◽  
Ischemic Complications ◽  
Posterior Circulation Aneurysms ◽  
The Relationship

BackgroundThe utility of using the VerifyNow P2Y12 platelet inhibition assay in patients undergoing Pipeline embolization of intracranial aneurysms remains controversial. As we have routinely employed the assay for patients undergoing flow diversion, we elected to explore the relationship between P2Y12 hyporesponse as indicated by a P2Y12 Reaction Units (PRU) value >200 and treatment outcomes, including intraprocedural platelet aggregation and ischemic complications.MethodsAll successful intracranial aneurysm Pipeline treatments performed at our institution from November 2011 to May 2019 were included. The rate of P2Y12 hyporesponse and treatment outcomes were evaluated. Multivariable logistic regression was utilized to determine independent predictors of treatment outcomes.Results333 qualifying treatments were performed in 297 patients. Clopidogrel hyporesponse was initially noted in 24%, falling to 17% by day-of-procedure by dose titration. A glycoprotein (GP) IIb/IIIa inhibitor was administered prophylactically in 3% of cases for persistent, profound hyporesponse. 27 (8.1%) patients developed acute platelet aggregation; only 6 demonstrated day-of-procedure P2Y12 hyporesponse. Day-of-procedure hyporesponse was not associated with intraprocedural platelet aggregation or ischemic complications. Greater Pipeline embolization device (PED) diameter was associated with a reduced odds of platelet aggregation (OR 0.38, 95% CI 0.17 to 0.85; p=0.019). Antiplatelet non-compliance (OR 25.20, 95% CI 3.86 to 164.61; p=0.001) and treatment of posterior circulation aneurysms (OR 5.23, 95% CI 1.22 to 22.33; p=0.026) were the only independent predictors of ischemic complications.ConclusionsP2Y12 hyporesponse was not associated with acute platelet aggregation or ischemic complications in our patients undergoing Pipeline embolization of intracranial aneurysms, possibly due to aggressive management of the hyporesponse using clopidogrel dose titration and/or GP IIb/IIIa inhibitor administration.

scholarly journals Insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysms after stent placement

2016 ◽  
Vol 125 (2) ◽  
pp. 247-253 ◽  
Author(s):  
Hongchao Yang ◽  
Youxiang Li ◽  
Yuhua Jiang
Keyword(s):  
Risk Factors ◽  
Regression Analysis ◽  
Intracranial Aneurysms ◽  
Platelet Inhibition ◽  
Thromboembolic Complications ◽  
Anterior Circulation ◽  
Stent Treatment ◽  
Independent Risk Factors ◽  
The Relationship

OBJECT Insufficient platelet inhibition has been associated with an increased incidence of thromboembolic complications in cardiology patients undergoing percutaneous coronary intervention. Data regarding the relationship between insufficient platelet inhibition and thromboembolic complications in patients undergoing neurovascular procedures remain controversial. The purpose of this study was to assess the relationship of insufficient platelet inhibition and thromboembolic complications in patients with intracranial aneurysm undergoing stent treatment. METHODS The authors prospectively recruited patients with intracranial aneurysms undergoing stent treatment and maintained the data in a database. MRI with diffusion-weighted sequences was performed within 24 hours of stent insertion to identify acute ischemic lesions. The authors used thromboelastography to assess the degree of platelet inhibition in response to clopidogrel and aspirin. Univariate and multivariate logistic regression analysis was used to identify potential risk factors of thromboembolic complications. RESULTS One hundred sixty-eight patients with 193 aneurysms were enrolled in this study. Ninety-one of 168 (54.2%) patients with acute cerebral ischemic lesions were identified by diffusion-weighted MRI. In 9 (5.4%) patients with ischemic lesions, transient ischemic attack or stroke was found at discharge, and these complications were found in 11 (6.5%) patients during the follow-up period. The incidence of periprocedural thromboembolic complications increased with resistance to antiplatelet agents, hypertension, hyperlipidemia, complete occlusion, and aneurysm of the anterior circulation. The multivariate regression analysis demonstrated that the anterior circulation and adenosine diphosphate (ADP) inhibition percentage were independent risk factors of perioperative thromboembolic complications. The maximum amplitude and ADP inhibition percentage were independent risk factors for thromboembolic complications during the follow-up period. CONCLUSIONS The ADP inhibition percentage is related to thromboembolic complications after stent placement for intracranial aneurysms. The increase of the ADP inhibition may decrease the risk of thromboembolic complications.

Multiple electrode aggregometry: A new device to measure platelet aggregation in whole blood

2006 ◽  
Vol 96 (12) ◽  
pp. 781-788 ◽  
Author(s):  
Andreas Calatzis ◽  
Sandra Penz ◽  
Hajna Losonczy ◽  
Wolfgang Siess ◽  
Orsolya Tóth
Keyword(s):  
Platelet Aggregation ◽  
Whole Blood ◽  
Blood Platelet ◽  
Platelet Inhibition ◽  
New Device ◽  
Platelet Aggregometry ◽  
Spontaneous Platelet Aggregation ◽  
Induced Aggregation ◽  
Blood Platelet Aggregation ◽  
Multiple Electrode

SummarySeveral methods are used to analyse platelet function in whole blood. A new device to measure whole blood platelet aggregation has been developed, called multiple electrode platelet aggregometry (MEA). Our aim was to evaluate MEA in comparison with the single platelet counting (SPC) method for the measurement of platelet aggregation and platelet inhibition by aspirin or apyrase in diluted whole blood. Platelet aggregation induced by different concentrations of ADP, collagen and TRAP-6 and platelet inhibition by apyrase or aspirin were determined in citrateor hirudin-anticoagulated blood by MEA and SPC. MEA indicated that spontaneous platelet aggregation was lower, and stimulated platelet aggregation was higher in hirudin- than citrate-anticoagulated blood. In hirudin-anticoagulated, but not citrate-anticoagulated blood, spontaneous platelet aggregation measured by MEA was inhibited by apyrase. For MEA compared with SPC the dose response-curves of agonist-induced platelet aggregation in citrate- and hirudin-blood showed similar EC50 values for TRAP, and higher EC50 values for ADP (non-significant) and collagen (p<0.05). MEA and the SPC method gave similar results concerning platelet-inhibition by apyrase and aspirin. MEA was more sensitive than SPC to the inhibitory effect of aspirin in collagen-induced aggregation. In conclusion, MEA is an easy, reproducible and sensitive method for measuring spontaneous and stimulated platelet aggregation, and evaluating antiplatelet drugs in diluted whole blood. The use of hirudin as an anticoagulant is preferable to the use of citrate. MEA is a promising technique for experimental and clinical applications.

scholarly journals MR-DWI–Positive Lesions and Symptomatic Ischemic Complications After Coiling of Unruptured Intracranial Aneurysms

Stroke ◽  
2013 ◽  
Vol 44 (3) ◽  
pp. 789-791 ◽  
Author(s):  
Dong-Hun Kang ◽  
Byung Moon Kim ◽  
Dong Joon Kim ◽  
Sang Hyun Suh ◽  
Dong Ik Kim ◽  
...  
Keyword(s):  
Intracranial Aneurysms ◽  
Unruptured Intracranial Aneurysms ◽  
Ischemic Complications

Abstract 3473: The Effect of Cigarette Smoking on the Antiplatelet Effect of Clopidogrel: The Smokers Paradox

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Paul Gurbel ◽  
Joseph Dichiara ◽  
Kevin P Bliden ◽  
Mark J Antonino ◽  
Lawal Lookman
Keyword(s):  
Platelet Aggregation ◽  
Cigarette Smoking ◽  
Metabolic Activation ◽  
Adenosine Diphosphate ◽  
Platelet Inhibition ◽  
Response Variability ◽  
Light Transmittance ◽  
Prior History ◽  
Platelet Response ◽  
Clopidogrel Therapy

Background: Wide response variability to clopidogrel therapy has been reported. Clopidogrel is a prodrug that requires metabolic activation by hepatic cytochromes (CYP). Cigarette smoking is an inducer of CYP1A2 and may, therefore, enhance the metabolism of clopidogrel. We sought to examine the effect of cigarette smoking on the platelet response to clopidogrel. Methods: Three hundred thirteen consecutive patients undergoing elective coronary stenting were studied. Platelet aggregation (PA) was assessed by light transmittance aggregometry (LTA) stimulated by 5 and 20μ M adenosine diphosphate. One hundred fourteen patients were on chronic clopidogrel therapy, were not reloaded, and had pre-stenting PA measurements. Pre-and post-stenting PA was measured in 199 patients: 60 were loaded with 300mg and 139 were loaded with 600mg. There were 120 current smokers (smoking within 2 weeks of PCI) and 193 non-smokers (no prior history of smoking). Low PA was defined as the lowest two quartiles of 5μM ADP-induced platelet aggregation (≤ 40%). Results: PA was significantly lower (p ≤ 0.008) in smokers on long term chronic clopidogrel treatment (Table ). Relative platelet inhibition (RPI) was higher in smokers treated with either 300mg or 600mg clopidogrel measured by 5 and 20μM ADP-induced PA. In a multivariate analysis, cigarette smoking was an independent predictor of low PA in patients on chronic clopidogrel therapy and in patients loaded with clopidogrel (r=0.3, p=0.0001). Conclusion: Clopidogrel therapy in smokers is associated with increased platelet inhibition and lower aggregation as compared to non-smokers. The mechanism of the smoking effect deserves further study and may be another cause of response variability to clopidogrel. RPI = 100 x ((baseline aggregation-post-treatment aggregation)/(baseline aggregation))

Treatment outcomes of 1-stage clipping of multiple unruptured intracranial aneurysms via keyhole approaches

2021 ◽  
pp. 1-10
Author(s):  
Noah Hong ◽  
Won-Sang Cho ◽  
Chang Hwan Pang ◽  
Young Hoon Choi ◽  
Jin Woo Bae ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Intracranial Aneurysms ◽  
Significant Risk ◽  
Treatment Modalities ◽  
Morbidity Rate ◽  
Chronic Hypertension ◽  
Unruptured Intracranial Aneurysms ◽  
Significant Difference ◽  
Complete Exclusion ◽  
Permanent Morbidity

OBJECTIVE Complete exclusion of multiple unruptured intracranial aneurysms (UIAs) in one session of intervention may be ideal. However, such situations are not always feasible in terms of treatment modalities and outcomes. The authors aimed to analyze their experience with 1-stage clipping of multiple UIAs. METHODS Medical records between March 2013 and December 2018 were retrospectively reviewed, and 111 1-stage keyhole approaches in 110 patients with 261 multiple UIAs were ultimately included in this study. Clinical and radiological outcomes were analyzed, as well as postoperative complications up to 1 month after the surgery and their risk factors. RESULTS Keyhole approaches included unilateral supraorbital in 87 operations (78.4%), bilateral supraorbital in 12 (10.8%), and others in 12. The mean operative duration was 169.6 minutes (range 80–490 minutes). The highest numbers of aneurysms clipped at once were 2 (73.9%) and 3 (18.9%). Complete exclusion and residual neck of the clipped aneurysms were achieved in 89.3% and 7.3%, respectively. There was no significant difference between pre- and postoperative 1-month neurological states (p = 0.14). The permanent morbidity rate was 1.8% (n = 2), and there were no deaths. Postoperative transient neurological deterioration (TND) with no radiological and electrophysiological abnormalities occurred in 8 operations (7.2%). Hypertension was the only significant risk factor for postoperative TND (adjusted odds ratio 17.03, 95% confidence interval 1.99–2232.24, p = 0.01). CONCLUSIONS One-stage clipping of multiple UIAs via keyhole approaches showed satisfactory treatment outcomes with a low permanent morbidity. Patients with chronic hypertension had a high risk of postoperative TND.

Lagrangian Trajectory Simulation of Platelets and Synchrotron Microtomography Augment Hemodynamic Analysis of Intracranial Aneurysms Treated With Embolic Coils

2021 ◽  
Vol 143 (7) ◽  
Author(s):  
Venkat Keshav Chivukula ◽  
Laurel Marsh ◽  
Fanette Chassagne ◽  
Michael C. Barbour ◽  
Cory M. Kelly ◽  
...  
Keyword(s):  
Shear Stress ◽  
Treatment Outcomes ◽  
Intracranial Aneurysms ◽  
Thrombus Formation ◽  
Vascular Wall ◽  
Cfd Modeling ◽  
Patient Specific ◽  
Embolic Coils ◽  
Endovascular Coils

Abstract As frequency of endovascular treatments for intracranial aneurysms increases, there is a growing need to understand the mechanisms for coil embolization failure. Computational fluid dynamics (CFD) modeling often simplifies modeling the endovascular coils as a homogeneous porous medium (PM), and focuses on the vascular wall endothelium, not considering the biomechanical environment of platelets. These assumptions limit the accuracy of computations for treatment predictions. We present a rigorous analysis using X-ray microtomographic imaging of the coils and a combination of Lagrangian (platelet) and Eulerian (endothelium) metrics. Four patient-specific, anatomically accurate in vitro flow phantoms of aneurysms are treated with the same patient-specific endovascular coils. Synchrotron tomography scans of the coil mass morphology are obtained. Aneurysmal hemodynamics are computationally simulated before and after coiling, using patient-specific velocity/pressure measurements. For each patient, we analyze the trajectories of thousands of platelets during several cardiac cycles, and calculate residence times (RTs) and shear exposure, relevant to thrombus formation. We quantify the inconsistencies of the PM approach, comparing them with coil-resolved (CR) simulations, showing the under- or overestimation of key hemodynamic metrics used to predict treatment outcomes. We fully characterize aneurysmal hemodynamics with converged statistics of platelet RT and shear stress history (SH), to augment the traditional wall shear stress (WSS) on the vascular endothelium. Incorporating microtomographic scans of coil morphology into hemodynamic analysis of coiled intracranial aneurysms, and augmenting traditional analysis with Lagrangian platelet metrics improves CFD predictions, and raises the potential for understanding and clinical translation of computational hemodynamics for intracranial aneurysm treatment outcomes.

scholarly journals Correction to: Ruptured PICA aneurysms: presentation and treatment outcomes compared to other posterior circulation aneurysms. A Swiss SOS study

2019 ◽  
Vol 161 (7) ◽  
pp. 1335-1336
Author(s):  
Daniele Starnoni ◽  
◽  
Rodolfo Maduri ◽  
Khalid Al Taha ◽  
David Bervini ◽  
...  
Keyword(s):  
Treatment Outcomes ◽  
Posterior Circulation ◽  
Posterior Circulation Aneurysms ◽  
Pica Aneurysms

Intracranial Aneurysms in Young Adult Patients: Surgical and Endovascular Treatment Outcomes

2020 ◽  
Vol 136 ◽  
pp. e214-e222
Author(s):  
Tae Keun Jee ◽  
Taek Min Nam ◽  
Je Young Yeon ◽  
Keon Ha Kim ◽  
Pyoung Jeon ◽  
...  
Keyword(s):  
Young Adult ◽  
Endovascular Treatment ◽  
Treatment Outcomes ◽  
Intracranial Aneurysms ◽  
Adult Patients

Early Operation for Ruptured Intracranial Aneurysms

Neurosurgery ◽  
1983 ◽  
Vol 12 (2) ◽  
pp. 169-174 ◽  
Author(s):  
Isao Yamamoto ◽  
Makoto Hara ◽  
Koichiro Ogura ◽  
Yoshio Suzuki ◽  
Toshichi Nakane ◽  
...  
Keyword(s):  
Ct Scan ◽  
Intracranial Aneurysms ◽  
Thick Layer ◽  
Early Operation ◽  
Computed Tomographic ◽  
Symptomatic Vasospasm ◽  
Ct Findings ◽  
Preoperative Ct ◽  
The Relationship ◽  
Ruptured Intracranial Aneurysms

Abstract The relationship between the results of early operation for ruptured intracranial aneurysms (72 cases) and the preoperative computed tomographic (CT) findings was studied. There was a correlation among the surgical results, the development of symptomatic vasospasm, and high density on the preoperative CT scan, particularly the presence of a localized, thick layer in the subarachnoid space. However, no relationship was found between the occurrence of ventricular enlargement and the preoperative CT findings. Cisternal or ventricular drainage might contribute to an uncomplicated postoperative course for patients with severe subarachnoid clot shown on the preoperative CT scan.

Association of Wall Stress of Human Intracranial Saccular Aneurysm With Coil Packing Density After Coil Embolization

2012 ◽  
Author(s):  
Joseph E. Pichamuthu ◽  
Alkiviadis Tsamis ◽  
Brian T. Jankowitz ◽  
David A. Vorp
Keyword(s):  
Coil Embolization ◽  
Intracranial Aneurysms ◽  
Cerebral Arteries ◽  
Wall Stress ◽  
Surgical Clipping ◽  
Risk Of Rupture ◽  
Relationship Of ◽  
The Relationship ◽  
Inside Out ◽  
Metallic Coils

Coil embolization has become a widely accepted endovascular procedure for intracranial aneurysms, as an alternative to surgical clipping [1,2]. This procedure involves treating an aneurysm from the inside out, whereby metallic coils are placed into the aneurysm to induce thrombosis of the lumen and eliminate the risk of rupture and hemorrhage. Successful endosaccular packing mainly depends on the morphological features and size of the aneurysm, and the relationship of the aneurysm to the cerebral arteries.

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