The Impact of Preprocedural Platelet Function Testing on Periprocedural Complication Rates Associated With Pipeline Flow Diversion: An International Multicenter Study

Author:

Vranic Justin E.1,Dmytriw Adam A.12ORCID,Berglar Inka K.1ORCID,Alotaibi Naif M.3,Cancelliere Nicole M.2,Stapleton Christopher J.1,Rabinov James D.1,Harker Pablo4,Gupta Rajiv1,Bernstock Joshua D.1,Koch Matthew J.5,Raymond Scott B.6,Mascitelli Justin R.7ORCID,Patterson T. Tyler7,Seinfeld Joshua8,White Andrew8,Case David8,Roark Christopher8,Gandhi Chirag D.9,Al-Mufti Fawaz9,Cooper Jared9,Matouk Charles10,Sujijantarat Nanthiya10,Devia Diego A.11,Ocampo-Navia Maria I.11,Villamizar-Torres Daniel E.11,Puentes Juan C.11,Salem Mohamed M.12,Baig Ammad13,El Namaani Kareem14,Kühn Anna Luisa15,Pukenas Bryan12,Jankowitz Brian T.12,Burkhardt Jan Karl12,Siddiqui Adnan13,Jabbour Pascal14,Singh Jasmeet15,Puri Ajit S.15,Regenhardt Robert W.1,Mendes Pereira Vitor2,Patel Aman B.1

Affiliation:

1. Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, Boston,Massachusetts, USA;

2. Neurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, USA;

3. Department of Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia;

4. Departments of Neurology and Rehabilitation Medicine, University of Cincinnati, Cincinnati, Ohio, USA;

5. Department of Neurosurgery, University of Florida, Gainesville, Florida, USA;

6. Department of Radiology, University of Vermont Medical Center, Burlington, Vermont, USA;

7. Department of Neurosurgery, University of Texas Health Science Center at San Antonio, Long School of Medicine, San Antonio, Texas, USA;

8. Department of Neurosurgery, University of Colorado, Denver, Colorado, USA;

9. Departments of Neurosurgery and Neurology, Westchester Medical Center, Valhalla, New York, USA;

10. Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA;

11. Departments of Radiology & Neurosurgery, Hospital Universitario San Ignacio, Bogotá, Colombia;

12. Department of Radiology & Neurosurgery, University of Pennsylvania School of Medicine, Pennsylvania, Pennsylvania, USA;

13. Department of Neurosurgery, State University of New York at Buffalo, Buffalo, New York, USA;

14. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA;

15. Department of Neurointerventional Radiology, UMass Memorial Hospital, Worcester, Massachusetts, USA

Abstract

BACKGROUND AND OBJECTIVES: 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. METHODS: 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 χ2 tests. A P-value <.05 was statistically significant. RESULTS: 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). CONCLUSION: 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.

Publisher

Ovid Technologies (Wolters Kluwer Health)

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