PMID- 31704360 OWN - NLM STAT- MEDLINE DCOM- 20200309 LR - 20200309 IS - 1878-8769 (Electronic) IS - 1878-8750 (Linking) VI - 134 DP - 2020 Feb TI - Preoperative Light Transmission Aggregometry Values Predict for Thromboembolic Complications After Stent-Assisted Coil Embolization. PG - e731-e738 LID - S1878-8750(19)32817-7 [pii] LID - 10.1016/j.wneu.2019.10.179 [doi] AB - OBJECTIVE: Risk control of thromboembolic complications (TECs) during stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) is crucial for satisfactory treatment outcomes. We retrospectively evaluated the data from our cohort of SACE for UIAs to analyze the role of anatomical, clinical, and stent type-related factors to determine the optimal preoperative values of light transmission aggregometry (LTA) for TEC prevention. METHODS: From July 2015 to May 2018, we retrospectively analyzed the data from 132 patients with SACE-treated UIAs at our hospital. Data regarding the aneurysm location, maximum diameter, stent type used, preoperative LTA value, and ischemic and hemorrhagic complications were collected. Aspirin 100 mg and clopidogrel 75 mg were started 7 days before surgery, with a "boost" dose (an additional 75 mg of clopidogrel for an LTA value >60%) added after August 2016 to address clopidogrel resistance. After multivariate analysis, we developed our original combined parameter termed the thromboembolic predictor (TEP). Receiver operating characteristic (ROC) analysis for TEP and each significant variable was performed. RESULTS: TECs were confirmed in 5 of the 132 patients (3.8%) and hemorrhagic complications in 9 of the 132 patients (6.8%). From the multivariate analysis results, the LTA value and maximum diameter were chosen as significant variables and included in the TEP. ROC analysis of the LTA value revealed a sensitivity and specificity of 0.866 and 0.600, respectively (area under the curve, 0.747), with a cutoff of 62%. TEP permitted the establishment of an optimal LTA value according to the aneurysm maximum diameter to predict for TECs. The complication rate for the Neuroform EZ, Enterprise, Neuroform Atlas, and LVIS stents was 2.9%, 10.5%, 1.4%, and 14.3%, respectively. CONCLUSIONS: The preoperative LTA value contributes to the prediction of TECs after SACE for UIAs. The TEP (relating the LTA cutoff to aneurysm size) allows for improved antiplatelet therapy adjustment before SACE to reduce TECs. CI - Copyright (c) 2019 Elsevier Inc. All rights reserved. FAU - Kan, Issei AU - Kan I AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. Electronic address: isseikan@gmail.com. FAU - Ishibashi, Toshihiro AU - Ishibashi T AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. FAU - Sakuta, Kenichi AU - Sakuta K AD - Department of Neurology, Jikei University Hospital, Tokyo, Japan. FAU - Fujimura, Soichiro AU - Fujimura S AD - Department of Innovation for Medical Information Technology, Jikei University School of Medicine, Tokyo, Japan; Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan. FAU - Yuki, Ichiro AU - Yuki I AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. FAU - Kaku, Shogo AU - Kaku S AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. FAU - Kodama, Tomonobu AU - Kodama T AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. FAU - Kato, Naoki AU - Kato N AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. FAU - Nishimura, Kengo AU - Nishimura K AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. FAU - Aoki, Ken AU - Aoki K AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. FAU - Sasaki, Yuichi AU - Sasaki Y AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. FAU - Karagiozov, Kostadin AU - Karagiozov K AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. FAU - Murayama, Yuichi AU - Murayama Y AD - Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. LA - eng PT - Journal Article DEP - 20191105 PL - United States TA - World Neurosurg JT - World neurosurgery JID - 101528275 RN - 0 (Platelet Aggregation Inhibitors) RN - A74586SNO7 (Clopidogrel) RN - R16CO5Y76E (Aspirin) SB - IM MH - Aspirin/therapeutic use MH - Clopidogrel/therapeutic use MH - *Embolization, Therapeutic MH - Endovascular Procedures MH - Female MH - Hematoma/epidemiology MH - Hemorrhage/epidemiology MH - Humans MH - Intracranial Aneurysm/*therapy MH - Male MH - Middle Aged MH - *Platelet Aggregation MH - Platelet Aggregation Inhibitors/*therapeutic use MH - Platelet Function Tests MH - Retrospective Studies MH - Risk Assessment MH - *Stents MH - Thromboembolism/*epidemiology OTO - NOTNLM OT - Antiplatelet therapy OT - Light transmission aggregometry OT - Stent-assisted coil embolization EDAT- 2019/11/11 06:00 MHDA- 2020/03/10 06:00 CRDT- 2019/11/10 06:00 PHST- 2019/08/23 00:00 [received] PHST- 2019/10/28 00:00 [revised] PHST- 2019/10/29 00:00 [accepted] PHST- 2019/11/11 06:00 [pubmed] PHST- 2020/03/10 06:00 [medline] PHST- 2019/11/10 06:00 [entrez] AID - S1878-8750(19)32817-7 [pii] AID - 10.1016/j.wneu.2019.10.179 [doi] PST - ppublish SO - World Neurosurg. 2020 Feb;134:e731-e738. doi: 10.1016/j.wneu.2019.10.179. Epub 2019 Nov 5.