Departments of1Medical Education.
2Neurosurgery, and.
Neurosurg Focus. 2023 Oct;55(4):E11. doi: 10.3171/2023.7.FOCUS23373.
Flow diverters have emerged as a popular modality for treating cerebral aneurysms but require dual antiplatelet therapy (DAPT) after placement. Clopidogrel is a common choice but is a prodrug that some patients may not convert into an active metabolite. The CYP2C19 genotype assay is used to predict activation speed; however, limited data exist showcasing whether this genotype accurately predicts postprocedure complications after flow diversion treatment of cerebral aneurysms. Therefore, the authors sought to characterize whether CYP2C19 genotype correlated with the development of postprocedure intimal hyperplasia (stenosis) after flow diverter placement.
Medical records were reviewed for patients who underwent flow diverter treatment of cerebral aneurysm at a single academic institution between January 1, 2012, and May 31, 2020. Patient demographics and comorbidities were reviewed alongside CYP2C19 genotype assay, DAPT regimen, and postprocedure angiogram data. Stenosis was defined based on review of angiogram data by two independent physicians.
In this review of 120 unique cerebral aneurysms, 102 received DAPT with clopidogrel and 18 received DAPT with an alternative agent. Stenosis was present on 3-month follow-up angiogram for 35/102 (34.3%) aneurysms receiving DAPT with clopidogrel and in 11/18 (61.1%) aneurysms receiving an alternative DAPT regimen (p = 0.031). The CYP2C19 genotype did not correlate with postprocedure stenosis (p = 0.35).
Clopidogrel was a significantly more effective DAPT agent for preventing stenosis when compared to nonclopidogrel DAPT regimens. The clopidogrel CYP2C19 genotype did not predict postprocedure stenosis in this cohort of 120 cerebral aneurysms treated with a flow diverter.
血流导向装置已成为治疗颅内动脉瘤的一种流行方式，但放置后需要双重抗血小板治疗（DAPT）。氯吡格雷是一种常用的选择，但它是一种前体药物，有些患者可能无法将其转化为活性代谢物。CYP2C19 基因型检测用于预测激活速度；然而，目前有限的数据表明，这种基因型是否能准确预测血流导向装置治疗颅内动脉瘤后术后的并发症。因此，作者试图研究 CYP2C19 基因型是否与血流导向装置放置后内膜增生（狭窄）的发生有关。
对 2012 年 1 月 1 日至 2020 年 5 月 31 日在一家学术机构接受血流导向装置治疗颅内动脉瘤的患者的病历进行了回顾性分析。分析了患者的人口统计学和合并症数据，以及 CYP2C19 基因型检测、DAPT 方案和术后血管造影数据。狭窄根据两名独立医生对血管造影数据的评估进行定义。
在这项对 120 个颅内动脉瘤的回顾性研究中，102 个动脉瘤接受了氯吡格雷的 DAPT，18 个动脉瘤接受了替代药物的 DAPT。在接受氯吡格雷 DAPT 的 102 个动脉瘤中，有 35 个（34.3%）在 3 个月的随访血管造影中出现狭窄，而在接受替代 DAPT 方案的 18 个动脉瘤中，有 11 个（61.1%）出现狭窄（p = 0.031）。CYP2C19 基因型与术后狭窄无关（p = 0.35）。
与非氯吡格雷 DAPT 方案相比，氯吡格雷是一种更有效的预防狭窄的 DAPT 药物。在这项接受血流导向装置治疗的 120 个颅内动脉瘤队列中，氯吡格雷 CYP2C19 基因型不能预测术后狭窄。
