Key result
Rapid CYP2C19 metabolism linked to ~54% rate of favorable 90-day prognosis after neurovascular intervention.
Why the study?
To investigate CYP2C19 gene polymorphism in acute ischemic stroke patients undergoing endovascular therapy to help improve prognosis and lower recurrence rates.
Does CYP2C19 rapid-metabolism genetic polymorphism improve prognosis and reduce recurrent ischemic events in patients receiving endovascular therapy on clopidogrel?
Cohort (n=480)
No
Does CYP2C19 rapid-metabolism genetic polymorphism improve prognosis and reduce recurrent ischemic events in patients receiving endovascular therapy on clopidogrel?
p-value: p=0.035
Patients with a rapid-metabolism CYP2C19 genotype have significantly greater platelet inhibition and lower rates of recurrent stroke and vessel restenosis when treated with clopidogrel following neuroendovascular interventions.
Rapid CYP2C19 metabolism was associated with better clopidogrel outcomes after endovascular therapy; hypothesis-generating for genotype-guided trials in stroke.
Background: Potentially substantial impacts on the prognosis have been observed in individuals undergoing endovascular treatment due to cytochrome P450 2c19 (C YP2C19 ) polymorphism. In an attempt to improve prognosis and lower the recurrence rate, this study investigated the CYP2C19 polymorphism in acute ischemic stroke patients. Materials and Methods: A retrospective analysis was performed on 292 patients with cerebral infarction who had acute endovascular recanalization at the Department of Neurology of Chongqing Hospital of Traditional Chinese Medicine between May 2017 and 2019. The patients were categorized into rapid-, medium-, and slow-metabolism groups based on CYP2C19 gene polymorphism, and their prognosis was monitored. In addition, the prognosis of 188 patients selectively receiving carotid artery stenting at a selected time was also observed. Results: Among the 292 cerebral infarction cases receiving acute endovascular recanalization, the patients in the CYP2C19 rapid-metabolism group regularly took clopidogrel and aspirin combined with antiplatelet therapy and suffered from reoccurrence of apoplexy and cerebral hemorrhage; the 90-day good prognosis had a statistical difference ( P < 0.05, prognostic assessment includes hospitalization and 6 months after discharge) and the other adverse events had no statistical difference (including mortality). The 188 patients selectively receiving carotid artery stenting had a recurrence of apoplexy, cerebral hemorrhage, and restenosis rate with a statistical difference ( P < 0.05), and the other adverse events had no statistical difference. Conclusions: In conclusion, the findings of the current study indicate that irrespective of whether patients are undergoing selective carotid artery stenting or acute endovascular recanalization, those with rapid CYP2C19 metabolism have a significantly lower likelihood of experiencing adverse prognostic events compared to those with intermediate and slow metabolism. Furthermore, this group also has a more favorable prognosis than the other two groups.
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Li et al. (2024) conducted a cohort in Cerebral infarction (n=480). CYP2C19 rapid-metabolism polymorphism vs. CYP2C19 medium and slow metabolism polymorphisms was evaluated on Favorable prognosis (mRS ≤2) at 90 days after endovascular recanalization (p=0.035). Patients with rapid CYP2C19 metabolism had a significantly higher rate of favorable 90-day prognosis (54.3%) and lower stroke recurrence rates compared to intermediate and slow metabolizers following endovascular therapy or carotid artery stenting.
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