Dual antiplatelet therapy after intracranial stents implantation for cerebral aneurysms
Abstract
Currently, protocols of dual antiplatelet therapy after the installation of intracranial stents are borrowed in interventional cardiology. But the presence of an extended defect of the artery wall in the neck of the aneurysm should be taken into account. Materials and methods. 200 patients with complex aneurysms after installation of flow diverters (100 patients) and embolization with stent-assisted coils (100 patients). Dual antiplatelet therapy was performed with clopidogrel 75 mg and acetylsalicylic acid 100 mg per day or with ticagrelor 90 mg 2 times a day (for insufficient reduction of functional activity of platelets). Results. The degree of aggregation decreased by an average of 54.7±19.6% (p=0.03) in the group of flow diverters, the velocity of aggregation decreased by an average of 41.5±8.1% (p=0.006), in the comparative group the degree of aggregation decreased by an average of 47.7±18.8% (p=0.04), the velocity of aggregation decreased by an average of 36.4±12.8% (p=0.03). The differences between the groups were not statistically significant. Conclusion. Monitoring of platelet aggregation capacity in the postoperative period by ADP-induced platelet aggregation is necessary to compare its possible benefits and risks for each patient and correction of dual antiplatelet therapy. Further study is required to develop common standards for dual antiplatelet therapy after the installation of intracranial stents.
About the Authors
E. M. Vyazgina
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
N. E. Ivanova
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
A. Yu. Ivanov
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
A. E. Petrov
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
L. V. Rozhchenko
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
G. P. Blagorazumova
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
S. A. Goroschenko
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
V. V. Bobinov
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
A. A. Ivanov
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
P. S. Sinitsyn
Polenov Neurosurgical Institute (branch of the Almazov National Medical Research Centre)
Russian Federation
Russian Federation
Saint Petersburg
References
1. Абугов С. А. и др. Рутиное мониторирование АДФиндуцированой агрегации тромбоцитов снижает риск развития подострого тромбоза стентов у больных ИБС с предстоящей плановой коронарной ангиопластикой //Международный журнал интервенционной кардиоангиологии. — 2008. — № . 14.
2. Зубков Ю. Н., Иванова Н. Е., Пирская Т. Н. Клиника постгеморрагической констриктивно-стенотической артериопатии и ишемии мозга при разрыве внутричерепных аневризм //Нейрохирургия. — 1999. — № . 1. — С. 13–18.
3. Панунцев В. С. и др. Содержание фактора Виллебранда в различных сосудистых бассейнах при нетравматических внутричерепных кровоизлияниях //Регионарное кровообращение и микроциркуляция. — 2004. — Т. 3. — № . 4. — С. 21–24.
4. Рожченко Л. В. и др. Коррекция тромбоэмболических осложнений при эндоваскулярных эмболизациях //Трансляционная медицина. — 2016. — Т. 3. — № . 1. — С. 98–105.
5. Becske T. et al. Pipeline for uncoilable or failed aneurysms: results from a multicenter clinical trial //Radiology. — 2013. — Т. 267. — № . 3. — С. 858–868.
6. Breet N. J. et al. Comparison of platelet function tests in predicting clinical outcome in patients undergoing coronary stent implantation //Jama. — 2010. — Т. 303. — № . 8. — С. 754–762.
7. Briganti F. et al. Treatment of intracranial aneurysms by flow diverter devices: long-term results from a single center //European journal of radiology. — 2014. — Т. 83. — № . 9. — С. 1683–1690.
8. Brinjikji W. et al. Risk factors for ischemic complications following pipeline embolization device treatment of intracranial aneurysms: results from the IntrePED study //American Journal of Neuroradiology. — 2016. — Т. 37. — № . 9. — С. 1673–1678.
9. Brunozzi D. et al. Middle cerebral artery flow velocity increases more in patients with delayed intraparenchymal hemorrhage after Pipeline //Journal of neurointerventional surgery. — 2018. — Т. 10. — № . 3. — С. 249–251.
10. Cagnazzo F. et al. Treatment of Distal Anterior Cerebral Artery Aneurysms with Flow-Diverter Stents: A Single-Center Experience //American Journal of Neuroradiology. — 2018.
11. Caroff J. et al. The occurrence of neointimal hyperplasia after flowdiverter implantation is associated with cardiovascular risks factors and the stent design //Journal of neurointerventional surgery. — 2018. — С. neurintsurg-2018–014441
12. Cekirge H. S., Saatci I. A new aneurysm occlusion classification after the impact of flow modification //American Journal of Neuroradiology. — 2016. — Т. 37. — № . 1. — С. 19
13. Cohen J. E. Anterior Communicating Artery Aneurysm: Large Aneurysm, Mass Effect, Deconstructive Techniques and Coiling, Occlusion, Mass Effect Relief and Excellent Evolution //The Aneurysm Casebook: A Guide to Treatment Selection and Technique. — 2018. — С. 1–8.
14. Consoli A. et al. Assisted coiling of saccular wide-necked unruptured intracranial aneurysms: stent versus balloon //Journal of neurointerventional surgery. — 2016. — Т. 8. — № . 1. — С. 52–57.
15. Giordan E. et al. Risk factors for growth of conservatively managed unruptured intracranial aneurysms //Acta neurochirurgica. — 2018. — Т. 160. — № . 12. — С. 2419–2423.
16. Girdhar G. et al. In-vitro thrombogenicity assessment of flow diversion and aneurysm bridging devices //Journal of thrombosis and thrombolysis. — 2015. — Т. 40. — № . 4. — С. 437–443.
17. Griessenauer C. J. et al. Pharmacy-mediated antiplatelet management protocol compared to one-time platelet function testing prior to pipeline embolization of cerebral aneurysms: a propensity scorematched cohort study //Neurosurgery. — 2018.
18. Gupta R. et al. Assessment of dual-antiplatelet regimen for pipeline embolization device placement: a survey of major academic neurovascular centers in the United States //World neurosurgery. — 2016. — Т. 96. — С. 285–292.
19. Hudson J. S. et al. Hemorrhage associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on a regimen of dual antiplatelet therapy: a retrospective analysis //Journal of neurosurgery. — 2018. — Т. 129. — № . 4. — С. 916–921.
20. Honma Y. et al. Comparison of intimal platelet accumulation in cerebral arteries in two experimental models of subarachnoid hemorrhage //Neurosurgery. — 1989. — Т. 24. — № . 4. — С. 487–490.
21. Kallmes D. F. et al. International retrospective study of the pipeline embolization device: a multicenter aneurysm treatment study //American Journal of Neuroradiology. — 2015. — Т. 36. — № . 1. — С. 108–115.
22. Lv X. et al. Potential advantages and limitations of the Leo stent in endovascular treatment of complex cerebral aneurysms //European journal of radiology. — 2011. — Т. 79. — № . 2. — С. 317–322.
23. Liu J. et al. Parent Artery Reconstruction for Large or Giant Cerebral Aneurysms Using the Tubridge Flow Diverter: A Multicenter, Randomized, Controlled Clinical Trial (PARAT) //American Journal of Neuroradiology. — 2018. — Т. 39. — № . 5. — С. 807–816.
24. Mahaney KB, Chalouhi N, Viljoen S, Smietana J, Kung DK, Jabbour P, et al. Risk of hemorrhagic complication associated with ventriculoperitoneal shunt placement in aneurysmal subarachnoid hemorrhage patients on dual antiplatelet therapy.// Journal Neurosurgery. — 2013. — T.119. — p.937–42
25. Matsuda Y. et al. A comparison between the new Low-profile Visualized Intraluminal Support (LVIS Blue) stent and the Flow Redirection Endoluminal Device (FRED) in bench-top and cadaver studies //Journal of neurointerventional surgery. — 2018. — Т. 10. — № . 3. — 274–278.
26. Mayberg M. R., Okada T., Bark D. H. The significance of morphological changes in cerebral arteries after subarachnoid hemorrhage //Journal of neurosurgery. — 1990. — Т. 72. — № . 4. — С. 626–633.
27. Parodi G. et al. High residual platelet reactivity after clopidogrel loading and long-term cardiovascular events among patients with acute coronary syndromes undergoing PCI //Jama. — 2011. — Т. 306. — № . 11. — С. 1215–1223.
28. Rajah G., Narayanan S., Rangel-Castilla L. Update on flow diverters for the endovascular management of cerebral aneurysms //Neurosurgical focus. — 2017. — Т. 42. — № . 6. — С. E2.
29. Smith R. R. et al. Cerebrospinal fluid factors following subarachnoid haemorrhage accelerate collagen lattice contraction by fibroblasts //Neurological research. — 1990. — Т. 12. — № . 1. — С. 41–44.
30. Trenk D. et al. Personalizing antiplatelet therapy with clopidogrel //Clinical Pharmacology & Therapeutics. — 2012. — Т. 92. — № . 4. — С. 476–485.
31. Wakhloo A. K. et al. Endovascular treatment of cerebral aneurysms //Stroke (Sixth Edition). — 2016. — С. 1071–1088. e6.
32. White A. C. et al. Patterns, Predictors, and Outcomes of Postprocedure Delayed Hemorrhage Following Flow Diversion for Intracranial Aneurysm Treatment //World neurosurgery. — 2018.
Review
For citations:
Vyazgina E.M., Ivanova N.E., Ivanov A.Yu., Petrov A.E., Rozhchenko L.V., Blagorazumova G.P., Goroschenko S.A., Bobinov V.V., Ivanov A.A., Sinitsyn P.S. Dual antiplatelet therapy after intracranial stents implantation for cerebral aneurysms. Russian Neurosurgical Journal named after Professor A. L. Polenov. 2019;11(1):8-14. (In Russ.)
Views:
96
Email this article 