Last-recorded P2Y12 Reaction Units Value is Strongly Associated with Thromboembolic and Hemorrhagic Complications Occurring Up to 6 Months After Treatment in Patients with Cerebral Aneurysms Treated with the Pipeline Embolization Device

Overview

Journal AJNR Am J Neuroradiol

Specialty Neurology

Date 2013 Jul 6

PMID 23828107

Citations 46

Authors

J E Delgado Almandoz

B M Crandall

J M Scholz

J L Fease

R E Anderson

Y Kadkhodayan

D E Tubman

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: A recent study identified a preprocedural P2Y12 reaction units value of <60 or >240 as a strong independent predictor of perioperative thromboembolic and hemorrhagic complications after treatment of cerebral aneurysms with the Pipeline Embolization Device. This study aimed to determine whether a last-recorded P2Y12 reaction units value of <60 or >240 predicts thromboembolic and hemorrhagic complications up to 6 months after treatment of cerebral aneurysms with the Pipeline Embolization Device in the same patient cohort.

Materials And Methods: We recorded patient and aneurysm characteristics, P2Y12 receptor antagonist administered, P2Y12 reaction units value with VerifyNow, procedural variables, and thromboembolic and hemorrhagic complications up to 6 months after Pipeline Embolization Device procedures at our institution during an 8-month period. Complications causing a permanent disabling neurologic deficit or death were considered major. Multivariate regression analysis was performed to identify independent predictors of thromboembolic and hemorrhagic complications.

Results: Forty-four patients underwent 48 Pipeline Embolization Device procedures at our institution during the study period. There were 11 thromboembolic and hemorrhagic complications up to 6 months after treatment in our cohort (22.9%), 5 of which were major (10.4%). A last-recorded P2Y12 reaction units value of <60 or >240 was the only independent predictor of all (P = .002) and major (P = .03) thromboembolic and hemorrhagic complications in our cohort. Most patients (71%) required, on average, 2 adjustments to the dose or type of P2Y12 receptor antagonist to remain within the 60-240 target P2Y12 reaction units range.

Conclusions: In our cohort, a last-recorded P2Y12 reaction units value of <60 or >240 was the only independent predictor of all and major thromboembolic and hemorrhagic complications up to 6 months after Pipeline Embolization Device procedures.

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References

Goh C, Churilov L, Mitchell P, Dowling R, Yan B . Clopidogrel hyper-response and bleeding risk in neurointerventional procedures. AJNR Am J Neuroradiol. 2013; 34(4):721-6. PMC: 7964475. DOI: 10.3174/ajnr.A3418. View

Delgado Almandoz J, Crandall B, Scholz J, Fease J, Anderson R, Kadkhodayan Y . Pre-procedure P2Y12 reaction units value predicts perioperative thromboembolic and hemorrhagic complications in patients with cerebral aneurysms treated with the Pipeline Embolization Device. J Neurointerv Surg. 2013; 5 Suppl 3:iii3-10. DOI: 10.1136/neurintsurg-2012-010582. View

Szikora I, Berentei Z, Kulcsar Z, Marosfoi M, Vajda Z, Lee W . Treatment of intracranial aneurysms by functional reconstruction of the parent artery: the Budapest experience with the pipeline embolization device. AJNR Am J Neuroradiol. 2010; 31(6):1139-47. PMC: 7963954. DOI: 10.3174/ajnr.A2023. View

Bonello L, Tantry U, Marcucci R, Blindt R, Angiolillo D, Becker R . Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate. J Am Coll Cardiol. 2010; 56(12):919-33. DOI: 10.1016/j.jacc.2010.04.047. View

Saatci I, Yavuz K, Ozer C, Geyik S, Cekirge H . Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results. AJNR Am J Neuroradiol. 2012; 33(8):1436-46. PMC: 7966552. DOI: 10.3174/ajnr.A3246. View

Lylyk P, Miranda C, Ceratto R, Ferrario A, Scrivano E, Luna H . Curative endovascular reconstruction of cerebral aneurysms with the pipeline embolization device: the Buenos Aires experience. Neurosurgery. 2009; 64(4):632-42. DOI: 10.1227/01.NEU.0000339109.98070.65. View

Jeong Y, Bliden K, Antonino M, Park K, Tantry U, Gurbel P . Usefulness of the VerifyNow P2Y12 assay to evaluate the antiplatelet effects of ticagrelor and clopidogrel therapies. Am Heart J. 2012; 164(1):35-42. DOI: 10.1016/j.ahj.2012.03.022. View

Akbari S, Reynolds M, Kadkhodayan Y, Cross 3rd D, Moran C . Hemorrhagic complications after prasugrel (Effient) therapy for vascular neurointerventional procedures. J Neurointerv Surg. 2012; 5(4):337-43. PMC: 3686254. DOI: 10.1136/neurintsurg-2012-010334. View

Varenhorst C, James S, Erlinge D, Braun O, Brandt J, Winters K . Assessment of P2Y(12) inhibition with the point-of-care device VerifyNow P2Y12 in patients treated with prasugrel or clopidogrel coadministered with aspirin. Am Heart J. 2009; 157(3):562.e1-9. DOI: 10.1016/j.ahj.2008.11.021. View

10.

Yu S, Kwok C, Cheng P, Chan K, Lau S, Lui W . Intracranial aneurysms: midterm outcome of pipeline embolization device--a prospective study in 143 patients with 178 aneurysms. Radiology. 2012; 265(3):893-901. DOI: 10.1148/radiol.12120422. View

11.

Fischer S, Vajda Z, Aguilar Perez M, Schmid E, Hopf N, Bazner H . Pipeline embolization device (PED) for neurovascular reconstruction: initial experience in the treatment of 101 intracranial aneurysms and dissections. Neuroradiology. 2011; 54(4):369-82. PMC: 3304061. DOI: 10.1007/s00234-011-0948-x. View

12.

Phillips T, Wenderoth J, Phatouros C, Rice H, Singh T, Devilliers L . Safety of the pipeline embolization device in treatment of posterior circulation aneurysms. AJNR Am J Neuroradiol. 2012; 33(7):1225-31. PMC: 7965498. DOI: 10.3174/ajnr.A3166. View

13.

Kan P, Siddiqui A, Veznedaroglu E, Liebman K, Binning M, Dumont T . Early postmarket results after treatment of intracranial aneurysms with the pipeline embolization device: a U.S. multicenter experience. Neurosurgery. 2012; 71(6):1080-7. DOI: 10.1227/NEU.0b013e31827060d9. View

14.

Colby G, Lin L, Gomez J, Paul A, Huang J, Tamargo R . Immediate procedural outcomes in 35 consecutive pipeline embolization cases: a single-center, single-user experience. J Neurointerv Surg. 2012; 5(3):237-46. DOI: 10.1136/neurintsurg-2012-010299. View

15.

Lubicz B, Collignon L, Raphaeli G, De Witte O . Pipeline flow-diverter stent for endovascular treatment of intracranial aneurysms: preliminary experience in 20 patients with 27 aneurysms. World Neurosurg. 2011; 76(1-2):114-9. DOI: 10.1016/j.wneu.2011.02.015. View

16.

Chitale R, Gonzalez L, Randazzo C, Dumont A, Tjoumakaris S, Rosenwasser R . Single center experience with pipeline stent: feasibility, technique, and complications. Neurosurgery. 2012; 71(3):679-91. DOI: 10.1227/NEU.0b013e318260fe86. View

17.

OKelly C, Spears J, Chow M, Wong J, Boulton M, Weill A . Canadian experience with the pipeline embolization device for repair of unruptured intracranial aneurysms. AJNR Am J Neuroradiol. 2012; 34(2):381-7. PMC: 7965091. DOI: 10.3174/ajnr.A3224. View

18.

von Beckerath N, Pogatsa-Murray G, Wieczorek A, Sibbing D, Schomig A, Kastrati A . Correlation of a new point-of-care test with conventional optical aggregometry for the assessment of clopidogrel responsiveness. Thromb Haemost. 2006; 95(5):910-1. DOI: 10.1160/th06-01-0046. View

19.

Altay T, Kang H, Woo H, Masaryk T, Rasmussen P, Fiorella D . Thromboembolic events associated with endovascular treatment of cerebral aneurysms. J Neurointerv Surg. 2011; 3(2):147-50. DOI: 10.1136/jnis.2010.003616. View

20.

Deutschmann H, Wehrschuetz M, Augustin M, Niederkorn K, Klein G . Long-term follow-up after treatment of intracranial aneurysms with the Pipeline embolization device: results from a single center. AJNR Am J Neuroradiol. 2011; 33(3):481-6. PMC: 7966428. DOI: 10.3174/ajnr.A2790. View