Rho Gyoung-Jun, Shin Woo-Ram, Kong Tae-Sik, Kim Min-Sun, Lee Chang-Ju, Lee Byung-Hee
Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea.
J Korean Neurosurg Soc. 2011 Jul;50(1):40-4. doi: 10.3340/jkns.2011.50.1.40. Epub 2011 Jul 31.
To evaluate the prevalence and risk factors of clopidogrel resistance, and association between thromboembolic complications and clopidogrel resistance in patient with stent-assisted angioplasty for atherosclerotic cerebrovascular disease.
Between September 2006 and June 2008, clopidogrel resistance test was performed on 41 patients who underwent stent-assisted angioplasty for atherosclerotic cerebrovascular disease. It was performed before drug administration and about 12 hours after drug administration (loading dose : 300 mg, maintain dose : 75 mg). Two patients were excluded, and 41 patients were included (mean : 67.59±7.10 years, age range : 41-79). Among 41 patients, 18 patients had intracranial lesions, and 23 had extracranial lesions. We evaluated the prevalence, risk factors and complications related to clopidogrel resistance.
Twenty-one patients (51.2%) showed clopidogrel resistance [intracranial : 10 patients (55.6%), extracranial : 11 patients (47.8%)] and no clopidogrel resistance was seen in 20 patients. Hypercholesterolemia was an indepedent risk factor of clopidogrel resistance. Stent-assisted angioplasty was technically successful in all patients, but acute in-stent thrombosis occurred in 5 patients with intracranial lesions (4 patients with clopidogrel resistance and 1 without clopidogrel resistance). Acute thrombi were completely lysed after intra-arterial infusion of abciximab.
There was relatively high prevalence of clopidogrel resistance in patients with atherosclerotic cerebrovascular disease. Hypercholesterolemia was an independent predictive factor of clopidogrel resistance. Acute in-stent thrombosis was more frequently seen in the clopidogrel resistant group. Therefore, clopidogrel resistance test should be performed to avoid thromboembolic complications related to stent-assisted angioplasty for atherosclerotic cerebrovascular disease, especially patients with hypercholeterolemia and intracranial lesion.
评估氯吡格雷抵抗在动脉粥样硬化性脑血管病支架辅助血管成形术患者中的发生率及危险因素，以及血栓栓塞并发症与氯吡格雷抵抗之间的关联。
2006年9月至2008年6月期间，对41例行动脉粥样硬化性脑血管病支架辅助血管成形术的患者进行氯吡格雷抵抗检测。在给药前及给药后约12小时（负荷剂量：300mg，维持剂量：75mg）进行检测。排除2例患者，纳入41例患者（平均年龄：67.59±7.10岁，年龄范围：41-79岁）。41例患者中，18例有颅内病变，23例有颅外病变。我们评估了与氯吡格雷抵抗相关的发生率、危险因素及并发症。
21例患者（51.2%）表现出氯吡格雷抵抗[颅内病变：10例患者（55.6%），颅外病变：11例患者（47.8%）]，20例患者未出现氯吡格雷抵抗。高胆固醇血症是氯吡格雷抵抗的独立危险因素。所有患者支架辅助血管成形术技术上均成功，但5例颅内病变患者发生急性支架内血栓形成（4例有氯吡格雷抵抗，1例无氯吡格雷抵抗）。动脉内输注阿昔单抗后急性血栓完全溶解。
动脉粥样硬化性脑血管病患者中氯吡格雷抵抗的发生率相对较高。高胆固醇血症是氯吡格雷抵抗的独立预测因素。急性支架内血栓形成在氯吡格雷抵抗组中更常见。因此，应进行氯吡格雷抵抗检测以避免动脉粥样硬化性脑血管病支架辅助血管成形术相关的血栓栓塞并发症，尤其是高胆固醇血症和颅内病变患者。
