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

      research-article
      , M.D., , M.D., Ph.D., , M.D., Ph.D., , M.D., Ph.D., , M.D., Ph.D., , M.D., Ph.D.
      Journal of Korean Neurosurgical Society
      Korean Neurosurgical Society
      Intracranial aneurysm, Stents, Thromboembolism, Platelet aggregation inhibitors

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          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.

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          Most cited references28

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          Endovascular treatment of unruptured aneurysms.

          We sought to better define the morbidity of endovascular Guglielmi detachable coil (GDC) treatment of unruptured cerebral aneurysms and to discuss its role in the prevention of subarachnoid hemorrhage. We conducted an observational study from August 1992 to June 1999 of 125 unruptured aneurysms treated with GDC in 116 patients: 91 women (78.4%) and 25 men (21.6%), aged 30 to 78 years (mean age, 50.6 years). Immediate and late clinical results were recorded for any neurological event or hemorrhage related to the treated unruptured aneurysm. Angiographic results are reported as immediate, early (2 to 12 months), intermediate (12 to 30 months), and late follow-up (>30 months). Immediate angiographic results showed complete obliteration (class 1) in 59 (47.2%) or residual neck (class 2) in 53 aneurysms (42.4%), leaving 6 residual aneurysms (4.8%) and 7 failures (5.6%). Early follow-up angiograms, available in 100 treated aneurysms (84%), revealed class 1 in 52% and class 2 in 41%. Intermediate angiograms, available in 53 aneurysms (44.5%), showed class 1 in 47.2% and class 2 in 43.4%, while late results, available in 37 lesions (31.1%), had class 1 and 2 in 48.6% and 37.8%, respectively. Six patients suffered a permanent neurological deficit at last follow-up (5.2%), with a good outcome in 5 patients and fair outcome in 1 patient. There was no mortality. There was no aneurysmal rupture during a mean clinical follow-up of 32.1 months. Endovascular treatment with GDC for unruptured aneurysms is relatively safe. Its role in the prevention of aneurysmal rupture remains to be determined, preferably by a randomized study.
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            • Record: found
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            Cerebral aneurysms.

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              • Record: found
              • Abstract: not found
              • Article: not found

              Endovascular treatment of intracranial aneurysms: current status.

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                Author and article information

                Journal
                J Korean Neurosurg Soc
                J Korean Neurosurg Soc
                jkns
                Journal of Korean Neurosurgical Society
                Korean Neurosurgical Society
                2005-3711
                1598-7876
                March 2018
                28 February 2018
                : 61
                : 2
                : 201-211
                Affiliations
                Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, Korea
                Author notes
                Address for reprints: Soon Chan Kwon, M.D., Ph.D., Department of Neurosurgery, Ulsan University Hospital, University of Ulsan College of Medicine, 877 Bangeojinsunhwando-ro, Dong-gu, Ulsan 44033, Korea, Tel : +82-52-250-7139, Fax : +82-52-250-7138, E-mail : nskwon.sc@ 123456gmail.com
                Article
                jkns-61-2-201
                10.3340/jkns.2017.0303.009
                5853205
                29526063
                eb1e68a5-ea41-4879-a11f-b6b0f203b84d
                Copyright © 2018 The Korean Neurosurgical Society

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 March 2017
                : 31 May 2017
                : 29 June 2017
                Categories
                Clinical Article

                Surgery
                intracranial aneurysm,stents,thromboembolism,platelet aggregation inhibitors
                Surgery
                intracranial aneurysm, stents, thromboembolism, platelet aggregation inhibitors

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