Management Of Antiplatelet Medications Research Articles

Antiplatelet Therapy and Platelet Activity Testing for Neurointerventional Procedures

The management of antiplatelet medications in neurointerventional procedures remains a subject of considerable variability and debate. This review article explores the diverse clinical practices and the impact of different antiplatelet regimens and platelet activity testing on patient outcomes in neurointerventional treatments. While much of the evidence around antiplatelet therapies largely stems from randomized trials in cardiac and peripheral vascular diseases, their application in neurointerventional settings requires nuanced consideration. Various assays exist to assess individual platelet function, yet the optimal assay, thresholds, and agents remain uncertain due to interpatient variability in medication responsiveness. Expert consensus groups have attempted to standardize antiplatelet management, which is summarized for elective and emergent neurointerventional procedures. Clopidogrel, a commonly used antiplatelet, faces challenges such as genetic variability in metabolism and drug–drug interactions, impacting its effectiveness. Other agents, such as ticagrelor and prasugrel, offer alternatives with different mechanisms of action and potential advantages. Additionally, short‐acting intravenous P2Y 12 inhibitors, such as cangrelor, and glycoprotein IIb/IIIa inhibitors provide options for acute bridging therapy in neurointerventional cases. Despite advancements, significant gaps persist in understanding the optimal antiplatelet management for neurovascular procedures. While platelet function testing is commonly used, its clinical utility and standardization remain an area of investigation. This review underscores the need for further multicenter studies to delineate best practices and optimize patient outcomes in neurointerventional settings.

Abstract T MP34: Perforator Proximity Is A Strong Independent Risk Factor For Peri-procedural Stroke In Intracranial Stenting For Atherosclerotic Disease With Aggressive Management Of Anti-platelet Therapy

Introduction: The majority of peri-procedural ischemic strokes in the SAMMPRIS trial were perforator strokes. Contemporary studies of intracranial stenting have not evaluated the proximity of atherosclerotic target lesions to major perforators. Methods: The current study evaluates a prospective aggressive anti-platelet therapy management approach at two institutions in a consecutive series of 158 patients with symptomatic intracranial atherosclerotic disease (ICAD) treated with angioplasty and stenting with self-expanding nitinol stents. Peri-procedural strokes were analyzed with respect to proximity of the target lesion to angiographically seen perforators and grouped as target lesion either within 2 mm, or greater than 2 mm from visible perforators. Results: A total of 158 patients with symptomatic ICAD were treated from 2005 to 2014. The periprocedural complication rate was 3.8% (6/158) with 1 subarachnoid hemorrhage, 0 intraparenchymal hemorrhages, 5 perforator strokes, and no stent thrombosis. With a mean follow up of 2.3 years, the total ipsilateral stroke and death rate was 6.3% (10/154). Of the 158 patients, 61 (38.6%) arteries were stented in the Middle Cerebral Artery or Basilar Artery. Twenty one of the target lesions were within 2 mm of visible perforators, and there were 4 perforator strokes (19%) in this subgroup. Forty of the target lesions were greater than 2 mm of visible perforators with one perforator stroke (2.5%) in this group. There was an approximately sevenfold higher risk of stroke with lesions within 2 mm of perforators compared to lesions greater than 2 mm in the same arteries. This was statistically significant (Fisher’s exact test, p = 0.0437). Conclusions: With aggressive monitoring and management of anti-platelet medications, intracranial stenting complications of stent thrombosis and distal emboli can be reduced, although there is still a significant risk of perforator strokes, particularly in the middle cerebral artery and basilar distributions. Target lesions within 2 mm of angiographically visualized perforators had a sevenfold higher risk for periprocedural stroke (p = 0.0437) than other lesions in the same arteries.

E-062 Intracranial Stenting for Atherosclerotic Disease with Aggressive Anti-platelet Therapy Management: A Consecutive Series of 154 Patients

IntroductionContemporary studies of intracranial stenting have utilised standard or aggressive medical therapy involving dual anti-platelet therapy, but have not evaluated anti-platelet therapy resistance as a component of treatment failure.MethodsThe current...

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