RESEARCH—HUMAN—CLINICAL STUDIES
Choi, Hyun Ho MD; Lee, Jung Jun MD; Cho, Young Dae MD,PhD; Han, Moon Hee MD,PhD, ; Cho, Won-Sang MD; Kim, Jeong Eun MD,PhD; An, Sang Joon MD; Mun, Jong Hyeon MD; Yoo, Dong Hyun MD; Kang, Hyun-Seung MD,PhD,
Department of Neurosurgery, Dongk-uk University Hospital, Dongkuk Unive-rsity College of Medicine, Ilsan, Korea
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
Correspondence: Hyun-Seung Kang, MD, PhD, Department of Neurosurgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea. E-mail: [email protected]
Abstract Associated Multimedia
BACKGROUND
The use of antiplatelet medications to prevent thrombosis in the treatment of cerebral aneurysms with stents has become widely emphasized.
OBJECTIVE
To compare low-dose prasugrel with clopidogrel in stent-assisted coil embolization of intracranial aneurysms.
METHODS
This is a retrospective review of 311 aneurysms from 297 patients who underwent stent-assisted endovascular coil embolization of unruptured intracranial aneurysm between November 2014 and March 2017. Thromboembolic and hemorrhagic adverse events were compared between 207 patients who received low-dose prasugrel (PSG group) and 90 patients who received clopidogrel (CPG group).
RESULTS
P2Y12 reaction unit (PRU) values were significantly lower in the PSG group (PSG group vs CPG group, 132.3 ± 76.9 vs 238.1 ± 69.1; P < .001); the percentage of inhibition was also statistically higher in the PSG group (54.0 ± 26.0% vs 20.8 ± 18.6%; P < .001). Thromboembolic events occurred less frequently in the PSG group than in the CPG group (0.9% vs 6.4%; P = .01), whereas there was no significant difference in the percentage of hemorrhagic complications (0.5% vs 2.2%; P = .22). In the multivariate analysis, clopidogrel as the antiplatelet medication was the sole significant risk factor for thromboembolism in this series of patients undergoing stent-assisted coil embolization.
CONCLUSION
Use of low-dose PSG as an antiplatelet premedication is quick, effective, and safe for stent-assisted coil embolization of unruptured intracranial aneurysms. Prasugrel premedication significantly lowered the frequency of thromboembolic events without increasing the risk of hemorrhage.
