Abstract
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.
Highlights
We have reported the incidence of thromboemboli as detected by postprocedural Transcranial Doppler sonography (TCD) following flow-diverting stent (FDS) treatment of unruptured aneurysms
Thromboembolic complication rates of up to 9.3% were reported in large series using the Pipeline FDS,[2,5,20] while the reported rate in stent-assisted aneurysm coiling was 2.0%–7.4%
Embolic phenomena are common after aneurysm coiling, and asymptomatic DWI abnormalities were found in 61%– 69% of patients on postprocedural MR imaging.[24,25]
Summary
The purpose of this study was to describe the incidence of microemboli on routine postprocedural TCD monitoring after FDS placement in a series of consecutive patients with unruptured aneurysms and to analyze the interaction between microemboli and platelet inhibition. Patient 13 (who was treated with a single coil in the aneurysm dome during the FDS procedure) was a responder on PRT (PRU 177).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
