Effect of Platelet Function Testing Guidance on Clinical Outcomes for Patients with Intracranial Aneurysms Undergoing Endovascular Treatment

BACKGROUND: Platelet function testing has been proposed to better adjust individualized antiplatelet treatment for patients undergoing endovascular treatment for intracranial aneurysms. Its clinical significance needs to be comprehensively evaluated. PURPOSE: Our aim was to evaluate the impact of platelet function testing–guided versus standard antiplatelet treatment in patients receiving endovascular treatment for intracranial aneurysms. DATA SOURCES: PubMed, EMBASE, and the Cochrane Library of clinical trials were searched from inception until March 2023. STUDY SELECTION: Eleven studies comprising 6199 patients were included. DATA ANALYSIS: ORs with 95% CIs were calculated using random effects models. DATA SYNTHESIS: The platelet function testing–guided group was associated with a decreased rate of symptomatic thromboembolic events (OR = 0.57; 95% CI, 0.42–0.76; I² = 26%). No significant difference was found in asymptomatic thromboembolic events (OR = 1.07; 95% CI, 0.39–2.94; I² = 48%), hemorrhagic events (OR = 0.71; 95% CI, 0.42–1.19; I² = 34%), intracranial hemorrhagic events (OR = 0.61; 95% CI, 0.03–10.79; I² = 62%), morbidity (OR = 0.53; 95% CI, 0.05–5.72; I² = 86%), and mortality (OR = 1.96; 95% CI, 0.64–5.97; I² = 0%) between the 2 groups. Subgroup analysis suggested that platelet function testing–guided therapy may contribute to fewer symptomatic thromboembolic events in patients who received stent-assisted coiling (OR = 0.43; 95% CI, 0.18–1.02; I² = 43%) or a combination of stent-assisted and flow-diverter stent placement (OR = 0.61; 95% CI, 0.36–1.02; I² = 0%) or who changed from clopidogrel to other thienopyridines (OR = 0.64; 95% CI, 0.40–1.02; I² = 18%), though the difference did not reach statistical significance. LIMITATIONS: Heterogeneous endovascular treatment methods and adjusted antiplatelet regimens were limitations. CONCLUSIONS: Platelet function testing–guided antiplatelet strategy significantly reduced the incidence of symptomatic thromboembolic events without any increase in the hemorrhagic events for patients undergoing endovascular treatment for intracranial aneurysms.