Antiplatelet Premedication for Stent-Assisted Coil Embolization of Intracranial Aneurysms: Low-Dose Prasugrel vs Clopidogrel.

Abstract

The use of antiplatelet medications to prevent thrombosis in the treatment of cerebral aneurysms with stents has become widely emphasized. To compare low-dose prasugrel with clopidogrel in stent-assisted coil embolization of intracranial aneurysms. 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). 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. 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.