J Korean Neurosurg Soc.  2018 Mar;61(2):201-211. 10.3340/jkns.2017.0303.009.

Clopidogrel Response Variability in Unruptured Intracranial Aneurysm Patients Treated with Stent-Assisted Endovascular Coil Embolization : Is Follow-Up Clopidogrel Response Test Necessary?

• Kim MS
• Park ES
• Park JB
• Lyo IU
• Sim HB
• Kwon SC

• KMID: 2408021
• DOI: http://doi.org/10.3340/jkns.2017.0303.009

Abstract

OBJECTIVE
The purpose of this study was to analyze the variability of clopidogrel responses according to duration of a clopidogrel drug regimen after stent-assisted coil embolization (SAC), and to determine the correlation between the variability of clopidogrel responses and thromboembolic or hemorrhagic complications.
METHODS
A total of 47 patients who underwent SAC procedures to treat unruptured intracranial aneurysms were enrolled in the study. Preoperatively, patients received more than seven days of aspirin (100 mg) and clopidogrel (75 mg), daily. P2Y12 reaction unit (PRU) was checked with the VerifyNow test one day before the procedure (pre-PRU) and one month after the procedure (post-PRU). PRU variability was calculated as the difference between the initial response and the follow-up response. Patients were sorted into two groups based on their response to treatment : responsive and hypo-responsive.
RESULTS
PRU variability was significantly greater in the hypo-responsive group when compared to the responsive group (p=0.019). Pre-PRU and serum platelets counts were significantly correlated with PRU variation (p=0.005 and p=0.004, respectively). Although thromboembolic complication had no significant correlated factors, hemorrhagic complication was correlated with pre-PRU (p=0.033).
CONCLUSION
In conclusion, variability of clopidogrel responses during clopidogrel medication was correlated to serum platelet counts and the initial clopidogrel response. Thromboembolic and hemorrhagic complications did not show correlation with the variability of clopidogrel response, or the clopidogrel response after one month of medication; however, hemorrhagic complication was associated with initial clopidogrel response. Therefore, it is recommended to test patients for an initial clopidogrel response only, as further tests would be insignificant.

Keyword

Intracranial aneurysm; Stents; Thromboembolism; Platelet aggregation inhibitors

MeSH Terms

Aspirin
Embolization, Therapeutic*
Follow-Up Studies*
Humans
Intracranial Aneurysm*
Platelet Aggregation Inhibitors
Platelet Count
Stents
Thromboembolism
Aspirin
Platelet Aggregation Inhibitors

Figure

• 

  Fig. 1 The patient was a 77-year-old woman who underwent a stent-assisted coil embolization procedure on an anterior communicating artery with an aneurysm 4.4 mm in size. One-year follow-up magnetic resonance imaging revealed a dot-like infarction in the left frontal lobe, but no symptoms. A : Anterior communicating artery aneurysm on angiography before the procedure. B : Anterior communicating artery aneurysm on angiography immediately after the procedure. C : Diffusion weighted imaging at one day after the procedure. D : Diffusion weighted imaging at one year post-operation (the arrow indicates a dot-like infarction).

• 

  Fig. 2 Clopidogrel response variability in unruptured intracranial aneurysm patients treated with stent assisted coil embolization from initial response to one month after the medication. A : Responsive group vs. hypo-responsive group. B : The variation of PRU from initial response to one month after the medication. PRU : P2Y12 reaction unit.

Reference

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