Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, People's Republic of China.
Department of Neurosurgery, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong, People's Republic of China.
Transl Stroke Res. 2024 Oct;15(5):902-909. doi: 10.1007/s12975-023-01171-3. Epub 2023 Jul 31.
To analyze the effect of tirofiban on ischemic events in CYP2C19 loss-of-function (LOF) allele carriers during pipeline embolization device (PED) implantation. Demographic information, imaging data, ischemic complications, CYP2C19 genotyping, and platelet function test results were collected from patients with PED-treated intracranial aneurysms at three centers. Multivariate logistic regression was used to analyze risk factors for ischemic events. Patients were grouped according to LOF alleles and antiplatelet drugs, the baseline information of LOF allele carriers and non-carriers were compared, and the efficacy of tirofiban was analyzed by comparing the incidence of ischemic events in each group. In total, 278 patients were included in the study, 24 of whom had an ischemic event. 157 (56.5%) patients carried the LOF allele and were more likely to develop resistance to clopidogrel (P < 0.001) and hypertension (P = 0.010). Multivariate logistic regression analysis revealed that the independent risk factors for ischemic events were age of > 55 years (OR = 3.308, P = 0.028), LOF alleles (OR = 3.960, P = 0.036), and clopidogrel nonresponsiveness (OR = 3.301, P = 0.014). For LOF allele carriers, prophylactic use of tirofiban after PED implantation helped to reduce ischemic events (4.3% vs. 16.4%, P = 0.039). This study supports CYP2C19 genotyping before flow diversion because LOF alleles increase the risk of ischemic events. Prophylactic use of tirofiban may help reduce ischemic events in LOF allele carriers.
分析 CYP2C19 功能丧失（LOF）等位基因携带者在Pipeline 栓塞装置（PED）植入期间发生缺血事件的影响。从三个中心接受 PED 治疗颅内动脉瘤的患者中收集人口统计学信息、影像学数据、缺血性并发症、CYP2C19 基因分型和血小板功能检测结果。使用多变量逻辑回归分析缺血事件的危险因素。根据 LOF 等位基因和抗血小板药物将患者分组，比较 LOF 等位基因携带者和非携带者的基线信息，并通过比较每组缺血事件的发生率分析替罗非班的疗效。共纳入 278 例患者，其中 24 例发生缺血事件。157（56.5%）例患者携带 LOF 等位基因，更易发生氯吡格雷抵抗（P < 0.001）和高血压（P = 0.010）。多变量逻辑回归分析显示，缺血事件的独立危险因素为年龄>55 岁（OR = 3.308，P = 0.028）、LOF 等位基因（OR = 3.960，P = 0.036）和氯吡格雷无反应性（OR = 3.301，P = 0.014）。对于 LOF 等位基因携带者，PED 植入后预防性使用替罗非班有助于减少缺血事件（4.3%比 16.4%，P = 0.039）。这项研究支持在血流改道前进行 CYP2C19 基因分型，因为 LOF 等位基因增加了缺血事件的风险。预防性使用替罗非班可能有助于减少 LOF 等位基因携带者的缺血事件。
