Relationship between adverse events and antiplatelet drug resistance in neurovascular intervention: a meta-analysis

BackgroundThis meta-analysis aimed to evaluate the association between antiplatelet resistance and the risk of procedure-related complications in neurovascular interventions.MethodsWe identified relevant articles by searching electronic databases and reviewed the reference lists of selected papers. The risk of adverse events between antiplatelet responders and hyporesponders during neurointervention was compared in eligible clinical studies. Risk ratios (RRs) and 95% CIs were pooled using a random-effects meta-analysis.ResultsOf 2134 potentially relevant studies, our search identified 15 studies enrolling a total of 2365 patients. Pooled RRs showed thromboembolic events (TEE) were more frequent in hyporesponders (RR 2.634, 95% CI 1.465 to 4.734). However, hemorrhagic complications did not differ between the two groups (RR 1.236, 95% CI 0.642 to 2.380). In subgroup analysis, hyporesponders showed a higher prevalence of TEE with standard antiplatelet medication, but there was no obvious difference in TEE between the two arms when using a modified antiplatelet medication (RR 3.645, 95% CI 1.537 to 8.646; and RR 1.877, 95% CI 0.749 to 4.751). Studies using stent placement for aneurysms showed a higher TEE rate in hyporesponders (RR 3.221, 95% CI 1.899 to 5.464).ConclusionAntiplatelet resistance was significantly associated with TEE in neurointervention, and this adverse event was associated with individually-intensified antiplatelet medication as well as the type of neurointerventional procedure. Our findings support the use of antiplatelet resistance assays and tailored antiplatelet medications in neurovascular stent placement as a management strategy to reduce thromboembolic risk.

Abstract WMP28: Association Between Diffusion Positive Lesion and Antiplatelet Drug Resistance After Coiling for Unruptured Intracranial Aneurysm

Background: The purpose of this study was to verify the association between immediate post-procedural thromboembolic infarction and antiplatelet drug resistance after endovascular coil embolization for unruptured intracranial aneurysm. Method: This study included 338 aneurysm cases between October 2012 and March 2015. All patients received post-procedural MRI within 48 hours after endovascular coil embolization. Antiplatelet drug resistance was checked a day before the procedure using the VerifyNow system. Abnormal antiplatelet response was defined as more than 550 aspirin response units (ARU) and more than 240 P2Y12 receptor reaction units (PRU). Also, we explored the optimal cutoff values of ARU and PRU. The primary outcome was radiologic infarction based on post-procedural MRI. Results: Among 338 unruptured intracranial aneurysms, 32 (9.5%) and 105 (31.1%) had abnormal ARU and PRU values, respectively. Radiologic infarction was associated with old age (≥65, adjusted odds ratio (OR)1.777, 95% confidence interval (CI) 1.080-2.925) only with defined abnormal antiplatelet response (ARU≥550, PRU≥240). PRU values in the top 10 th percentile (>294) were associated with radiologic infarction ( p =0.003, OR 4.8, 95% CI 1.708-13.492). Using this cutoff value, age (OR 2.287, 95% CI 1.282-4.079), PRU (>294, OR 3.431 95% CI 1.528-7.706), and hyperlipidemia (OR 2.046 95% CI 1.041-4.020) were associated with radiologic infarction in multivariate analysis. Conclusions: Radiologic infarction after coiling for unruptured aneurysm was closely associated with age. Only very high PRU values (>294) predicted post-procedural infarction. Further controlled studies are needed to determine precise cutoff values which could provide information regarding the optimal antiplatelet regimen for aneurysm coiling.