Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA.
Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , USA.
Neurosurgery. 2024 Jul 1;95(1):179-185. doi: 10.1227/neu.0000000000002956. Epub 2024 Apr 18.
Dual antiplatelet therapy (DAPT) is necessary to minimize the risk of periprocedural thromboembolic complications associated with aneurysm embolization using pipeline embolization device (PED). We aimed to assess the impact of platelet function testing (PFT) on reducing periprocedural thromboembolic complications associated with PED flow diversion in patients receiving aspirin and clopidogrel.
Patients with unruptured intracranial aneurysms requiring PED flow diversion were identified from 13 centers for retrospective evaluation. Clinical variables including the results of PFT before treatment, periprocedural DAPT regimen, and intracranial complications occurring within 72 h of embolization were identified. Complication rates were compared between PFT and non-PFT groups. Differences between groups were tested for statistical significance using the Wilcoxon rank sum, Fisher exact, or χ 2 tests. A P -value <.05 was statistically significant.
580 patients underwent PED embolization with 262 patients dichotomized to the PFT group and 318 patients to the non-PFT group. 13.7% of PFT group patients were clopidogrel nonresponders requiring changes in their pre-embolization DAPT regimen. Five percentage of PFT group [2.8%, 8.5%] patients experienced thromboembolic complications vs 1.6% of patients in the non-PFT group [0.6%, 3.8%] ( P = .019). Two (15.4%) PFT group patients with thromboembolic complications experienced permanent neurological disability vs 4 (80%) non-PFT group patients. 3.7% of PFT group patients [1.5%, 8.2%] and 3.5% [1.8%, 6.3%] of non-PFT group patients experienced hemorrhagic intracranial complications ( P > .9).
Preprocedural PFT before PED treatment of intracranial aneurysms in patients premedicated with an aspirin and clopidogrel DAPT regimen may not be necessary to significantly reduce the risk of procedure-related intracranial complications.
使用Pipeline 栓塞装置（PED）栓塞动脉瘤时，双联抗血小板治疗（DAPT）是必要的，以最大程度降低围手术期血栓栓塞并发症的风险。我们旨在评估血小板功能检测（PFT）对减少接受阿司匹林和氯吡格雷双重抗血小板治疗的患者中与 PED 血流分流相关的围手术期血栓栓塞并发症的影响。
从 13 个中心回顾性评估需要 PED 血流分流的未破裂颅内动脉瘤患者。确定了治疗前的临床变量，包括 PFT 结果、围手术期 DAPT 方案以及栓塞后 72 小时内发生的颅内并发症。比较 PFT 组和非 PFT 组的并发症发生率。使用 Wilcoxon 秩和检验、Fisher 确切检验或 χ 2 检验检验组间差异的统计学意义。P<.05 为统计学显著。
580 例患者接受了 PED 栓塞，其中 262 例患者分为 PFT 组，318 例患者分为非 PFT 组。PFT 组 13.7%的患者为氯吡格雷无反应者，需要改变其术前 DAPT 方案。PFT 组有 5%的患者[2.8%，8.5%]发生血栓栓塞并发症，而非 PFT 组有 1.6%的患者[0.6%，3.8%]发生血栓栓塞并发症（P =.019）。PFT 组有 2 例（15.4%）血栓栓塞并发症患者发生永久性神经功能障碍，而非 PFT 组有 4 例（80%）患者发生永久性神经功能障碍。PFT 组有 3.7%的患者[1.5%，8.2%]和非 PFT 组有 3.5%的患者[1.8%，6.3%]发生颅内出血并发症（P>.9）。
在接受阿司匹林和氯吡格雷双重抗血小板治疗的患者中，在 PED 治疗颅内动脉瘤之前进行术前 PFT 可能并不能显著降低与手术相关的颅内并发症的风险。
