title: Prasugrel is effective and safe for neurointerventional procedures.
abstract: BACKGROUND
  Clopidogrel bisulfate and aspirin are routinely administered as dual antiplatelet agents for many neurointerventional procedures, especially for intravascular stent placement. Many patients are non-responsive to clopidogrel, either secondary to drug interactions or from variations of cytochrome P450 enzymes. Prasugrel (brand name Effient, Eli Lilly and Company, Indianapolis, IN, USA) is a new antiplatelet agent that has been utilized extensively in patients undergoing cardiovascular procedures but its safety and efficacy during neurointerventional procedures have not been evaluated.
  
  
  OBJECTIVE
  To examine whether prasugrel is a safe and effective alternative to clopidogrel for neurointerventional procedures, especially in those patients who are either non-responders or allergic to clopidogrel.
  
  
  METHODS
  The medical records of all patients undergoing neurointerventional procedures at our institution who received prasugrel between January 2009 and July 2011 were retrospectively reviewed. A systematic chart review was performed and the following data were recorded: demographics, aneurysm location, endovascular techniques, peri- and post-procedural complications, hemorrhagic complications, clinical outcome and angiographic outcome.
  
  
  RESULTS
  16 patients undergoing neurointerventional procedures received prasugrel over a 2 year interval. All patients who had follow-up studies of P2Y12 inhibition had immediate therapeutic response to prasugrel. There were no complications related to ischemic or intracranial hemorrhage.
  
  
  CONCLUSIONS
  Prasugrel is a viable alternative to clopidogrel for patients undergoing neurointerventional procedures who are non-responders to clopidogrel. Further study is needed to evaluate the safety, efficacy and cost-effectiveness of prasugrel compared with clopidogrel for patients undergoing neurointerventional procedures.
authors.affiliation: Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: William R
authors.initials: WR
authors.lastname: Stetler
authors.forename: Neeraj
authors.initials: N
authors.lastname: Chaudhary
authors.forename: Byron Gregory
authors.initials: BG
authors.lastname: Thompson
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Gemmete
authors.forename: Cormac O
authors.initials: CO
authors.lastname: Maher
authors.forename: Aditya S
authors.initials: AS
authors.lastname: Pandey
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D057510:Endovascular Procedures / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000008:administration & dosage* / Q000009:adverse effects; D010879:Piperazines / Q000008:administration & dosage* / Q000009:adverse effects; D000068799:Prasugrel Hydrochloride; D058921:Purinergic P2Y Receptor Antagonists / Q000008:administration & dosage* / Q000009:adverse effects; D058925:Receptors, Purinergic P2Y12 / Q000378:metabolism; D012189:Retrospective Studies; D013876:Thiophenes / Q000008:administration & dosage* / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D018696:Neuroprotective Agents; D010879:Piperazines; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D013876:Thiophenes; D000068799:Prasugrel Hydrochloride