Introduction: Stent-assisted coiling of intracranial aneurysms is a viable and efficient treatment alternative to surgical clipping but requires prolonged antiplatelet therapy. Some patients can be non-responsive to aspirin and/or clopidogrel. This is the first study analyzing the implications of this assessment using the “whole blood aggregometry (WBA) by impedance” technique.
Methods: The Southwestern Tertiary Aneurysm Registry (STAR) was reviewed between 2002 and 2012 for patients with unruptured aneurysms treated with stent-assisted coiling. The study population was divided into patients who were tested pre-operatively for platelet responsiveness to aspirin and clopidogrel (“tested” patients) and those who were not (“non-tested” patients). Where necessary, a majority of tested patients received additional doses of anti-platelet drugs to achieve adequate platelet inhibition. Endpoints included the incidence of antiaggregant non-responsiveness, the rates of thrombotic and hemorrhagic complications, and the rates of permanent morbidity and mortality.
Results: A total of 266 patients fulfilled our selection criteria. There were 114 non-tested patients who underwent 121 procedures, and 152 tested patients who underwent 171 procedures. The two groups did not vary significantly in patient age, gender, and aneurysms location. Aspirin non-responsiveness was detected in 3 patients (1.75%) and clopidogrel non-responsiveness in 21 patients (12.3%). Non-tested patients had an 11.5% rate of thrombotic complications with a 4.23% permanent morbidity or mortality rate versus 2.3% and 0.58% in tested patients (p=0.0013). The incidence of hemorrhagic complications was similar between the two groups.
Conclusions: Preoperative platelet inhibition testing using WBA can be useful to assess and correct antiaggregant non-responsiveness, and may reduce post-operative mortality and permanent morbidity.
Patient Care: Making whole blood aggregometry testing prior to endovascular procedures a standard of care will help detect aspirin and Plavix non-responsiveness, and identify patients who require additional bolusing prior to their procedure. This practice has the potential to significantly reduce thrombotic complications whithout adding to bleeding risk.
Learning Objectives: -Identify the role of adequate aspirin and Plavix effect prior to endovascular stent-assisted coiling of brain aneurysms
-Recognize the role of whole blood aggregometry in assessing and correcting antiaggregant non-responsiveness