Abstract
Background and Purpose: Antiplatelet therapy is essential for preventing thrombotic complications in neuro-endovascular treatment (NET). However, it has been clarified that there are poor responders of antiplatelet drugs. The present study was conducted to evaluate the usefulness of platelet reactivity monitoring for predicting thrombotic or hemorrhagic event in patients underwent NET. Methods: Between May 2010 and Mar 2013, we enrolled 617 patients who were planning to undergo elective carotid artery stenting or aneurysmal coil embolization in 7 Japanese centers. Antiplatelet therapy was started at least two days before, and platelet reactivity was measured with Verify Now system at beginning of the procedure. Patients were followed for 1 year. Thrombotic events (ischemic stroke, myocardial infarction, or systemic embolization) and hemorrhagic events (intracranial or major systemic hemorrhage) were examined. We evaluated the relationships between platelet reactivity and occurrences of thrombotic/hemorrhagic events. Results: A total of 595 patients (270 men, 63.7±11.9 years old) with sufficient data were analyzed. Thrombotic and hemorrhagic events were observed in 38 (6.4%) and 19 (3.2%) patients within 30 days, and additionally observed in 4 (0.6%) and 10 (1.7%) patients between 31 days and 1 year after the procedure. With receiver operating characteristic analysis, optimal cut-off values for predicting thrombotic events were P2Y12 reaction units (PRU) >225 (area under the curve: 0.57). Higher platelet reactivity was related to higher incidence of thrombotic events within 1 year (10.0% vs 4.3%, Log rank P225 (HR 2.55, 95% CI 1.24-4.87, P=0.01) and prior cerebrovascular disease (HR 2.83, 95% CI 1.48-5.40, P<0.01) were the predictors of thrombotic events within 1 year after the procedure. Low platelet reactivity on P2Y12 was not associated with hemorrhagic events. Conclusion: High platelet reactivity on P2Y12 (PRU>225) can predict thrombotic events after NET. Safer drugs or tailored strategies may be needed to reduce the complications in patients with cerebrovascular diseases.
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