RT Journal Article
SR Electronic
T1 Incidence of Microemboli and Correlation with Platelet Inhibition in Aneurysmal Flow Diversion
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A3627
A1 Levitt, M.R.
A1 Ghodke, B.V.
A1 Hallam, D.K.
A1 Sekhar, L.N.
A1 Kim, L.J.
YR 2013
UL http://www.ajnr.org/content/early/2013/06/27/ajnr.A3627.abstract
AB SUMMARY: Flow-diverting stents have been associated with embolic and hemorrhagic complications, but the rate of procedure-related microemboli is unknown. Using transcranial Doppler sonography, we measured the rate of microemboli in 23 patients treated with flow-diverting stents. Patients received preprocedural dual antiplatelet medications and intraprocedural heparinization. Point-of-care platelet reactivity testing was performed before the procedure, and nonresponders (>213 P2Y12/ADP receptor reactivity units) received additional thienopyridine. Transcranial Doppler sonography was performed within 12–24 hours. Microemboli were detected in 3 patients (13%), 2 of whom were initially nonresponders. There was no association between the presence of microemboli and procedural or neurologic complications, aneurysm size, number of stents, or procedure time. Eight procedures (34.8%) required additional thienopyridine for inadequate platelet inhibition, and 3 required further treatment for persistent nonresponse to point-of-care platelet reactivity testing. There were 6 technical and 2 postoperative complications; none were associated with inadequate platelet inhibition or microemboli. The combination of routine point-of-care platelet reactivity testing and postprocedural microembolic monitoring may help identify patients at risk for thromboembolic complications after flow-diverting stents. Abbreviations FDSflow-diverting stentPRTpoint-of-care platelet reactivity testingPRUP2Y12/adenosine diphosphate receptor reactivity unitsTCDtranscranial Doppler sonography