在植入管道栓塞装置前进行血小板功能检测的应用：一项多中心队列研究。
Use of Platelet Function Testing Before Pipeline Embolization Device Placement: A Multicenter Cohort Study.
作者信息
Adeeb Nimer, Griessenauer Christoph J, Foreman Paul M, Moore Justin M, Shallwani Hussain, Motiei-Langroudi Rouzbeh, Alturki Abdulrahman, Siddiqui Adnan H, Levy Elad I, Harrigan Mark R, Ogilvy Christopher S, Thomas Ajith J
机构信息
From the Neurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA (N.A., C.J.G., J.M.M., R.M.-L., A.A., C.S.O., A.J.T.); Department of Neurosurgery, University of Alabama at Birmingham (P.M.F., M.R.H.); and Department of Neurosurgery, State University of New York at Buffalo (H.S., A.H.S., E.I.L.).
出版信息
Stroke. 2017 May;48(5):1322-1330. doi: 10.1161/STROKEAHA.116.015308. Epub 2017 Apr 14.
BACKGROUND AND PURPOSE
Thromboembolic complications constitute a significant source of morbidity after neurointerventional procedures. Flow diversion using the pipeline embolization device for the treatment of intracranial aneurysms necessitates the use of dual antiplatelet therapy to reduce this risk. The use of platelet function testing before pipeline embolization device placement remains controversial.
METHODS
A retrospective review of prospectively maintained databases at 3 academic institutions was performed from the years 2009 to 2016 to identify patients with intracranial aneurysms treated with pipeline embolization device placement. Clinical and radiographic data were analyzed with emphasis on thromboembolic complications and clopidogrel responsiveness.
RESULTS
A total of 402 patients underwent 414 pipeline embolization device procedures for the treatment of 465 intracranial aneurysms. Thromboembolic complications were encountered in 9.2% of procedures and were symptomatic in 5.6%. Clopidogrel nonresponders experienced a significantly higher rate of thromboembolic complications compared with clopidogrel responders (17.4% versus 5.6%). This risk was significantly lower in nonresponders who were switched to ticagrelor when compared with patients who remained on clopidogrel (2.7% versus 24.4%). In patients who remained on clopidogrel, the rate of thromboembolic complications was significantly lower in those who received a clopidogrel boost within 24 hours pre-procedure when compared with those who did not (9.8% versus 51.9%). There was no significant difference in the rate of hemorrhagic complications between groups.
CONCLUSIONS
Clopidogrel nonresponders experienced a significantly higher rate of thromboembolic complications when compared with clopidogrel responders. However, this risk seems to be mitigated in nonresponders who were switched to ticagrelor or received a clopidogrel boost within 24 hours pre-procedure.
背景与目的
血栓栓塞性并发症是神经介入手术后发病的重要原因。使用管道栓塞装置进行血流导向治疗颅内动脉瘤时，需要采用双重抗血小板治疗以降低这种风险。在放置管道栓塞装置前进行血小板功能检测仍存在争议。
方法
对3家学术机构2009年至2016年前瞻性维护的数据库进行回顾性研究，以确定接受管道栓塞装置置入治疗的颅内动脉瘤患者。分析临床和影像学数据，重点关注血栓栓塞性并发症和氯吡格雷反应性。
结果
共有402例患者接受了414次管道栓塞装置手术，治疗465个颅内动脉瘤。9.2%的手术出现血栓栓塞性并发症，其中5.6%有症状。与氯吡格雷反应者相比，氯吡格雷无反应者发生血栓栓塞性并发症的比例显著更高（17.4%对5.6%）。与继续使用氯吡格雷的患者相比，改用替格瑞洛的无反应者发生这种风险显著更低（2.7%对24.4%）。在继续使用氯吡格雷的患者中，术前24小时内接受氯吡格雷强化治疗的患者发生血栓栓塞性并发症的比例显著低于未接受强化治疗的患者（9.8%对51.9%）。各组间出血性并发症发生率无显著差异。
结论
与氯吡格雷反应者相比，氯吡格雷无反应者发生血栓栓塞性并发症的比例显著更高。然而，对于改用替格瑞洛或术前24小时内接受氯吡格雷强化治疗的无反应者，这种风险似乎有所降低。
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