Key result
ADP-MPA predicts ischemic events during endovascular treatment of intracranial aneurysms with ~0.75 AUC.
Why the study?
LTA and CYP2C19 genotype analysis evaluate clopidogrel antiplatelet effects during interventional treatment of intracranial aneurysms, but which test predicts ischaemic events remained unclear.
Does light transmission aggregometry (LTA) or CYP2C19 genotype analysis predict ischaemic complications in patients undergoing interventional therapy for intracranial aneurysms?
Observational (n=379)
Does light transmission aggregometry (LTA) or CYP2C19 genotype analysis predict ischaemic complications in patients undergoing interventional therapy for intracranial aneurysms?
ADP-MPA, but not CYP2C19 genotype, is a useful predictor of ischaemic complications during endovascular treatment of intracranial aneurysms, with lower cut-off values required for flow diverters compared to traditional stents.
ADP-MPA may identify high-risk patients during aneurysm embolization; leaves open whether testing-guided therapy improves outcomes.
BACKGROUND AND PURPOSE: Light transmission aggregometry (LTA) and CYP2C19 genotype analysis are commonly used to evaluate the antiplatelet effects of clopidogrel during the interventional treatment of intracranial aneurysms. The aim of this study was to determine which test can predict ischaemic events during these treatments. METHODS: Patient demographic information, imaging data, laboratory data and ischaemic complications were recorded. LTA and CYP2C19 genotype results were compared, and multiple linear regression was performed to examine factors related to platelet reactivity. Multivariate regression analysis was performed to determine whether LTA and CYP2C19 could predict ischaemic complications and to identify other clinical risk factors. Receiver operating characteristic curve analysis was conducted to calculate the cut-off value for predicting ischaemic complications. A subgroup analysis was also performed for different CYP2C19 genotype metabolisers, as well as for patients with flow diverters and traditional stents. RESULTS: A total of 379 patients were included, of which 22 developed ischaemic events. Maximum platelet aggregation induced by ADP (ADP-MPA) could predict ischaemic events (p<0.001; area under the curve, 0.752 (95% CI 0.663 to 0.842)), and its cut-off value was 41.5%. ADP-MPA (p=0.001) and hypertension duration >10 years (p=0.022) were independent risk factors for ischaemic events, while the CYP2C19 genotype was not associated with ischaemic events. In the subgroup analysis, ADP-MPA could predict ischaemic events in fast metabolisers (p=0.004) and intermediate metabolisers (p=0.003). The cut-off value for ischaemic events was lower in patients with flow diverters (ADP-MPA=36.4%) than in patients with traditional stents (ADP-MPA=42.9%). CONCLUSIONS: ADP-MPA can predict ischaemic complications during endovascular treatment of intracranial aneurysms. Patients with flow diverters require stronger antiplatelet medication than patients with traditional stents.
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Zhou et al. (2023) conducted an observational in Intracranial aneurysms (n=379). Light transmission aggregometry (LTA) and CYP2C19 genotype analysis was evaluated on Ischaemic events (AUC 0.752, 95% CI 0.663 to 0.842, p=<0.001). Maximum platelet aggregation induced by ADP (ADP-MPA) predicted ischaemic events during endovascular treatment of intracranial aneurysms (AUC 0.752; 95% CI 0.663 to 0.842; p<0.001).
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