title: Pre-procedure P2Y12 reaction units value predicts perioperative thromboembolic and hemorrhagic complications in patients with cerebral aneurysms treated with the Pipeline Embolization Device.
abstract: BACKGROUND
  There is wide variability in the reported incidence of perioperative thromboembolic (0-14%) and hemorrhagic (0-11%) complications after Pipeline Embolization Device (PED) procedures for cerebral aneurysm treatment, which could be partly due to differences in patient response to the P2Y12 receptor antagonist administered while the PED endothelializes. This study aims to identify an optimal pre-procedure P2Y12 reaction units (PRU) value range and determine the independent predictors of perioperative thromboembolic and hemorrhagic complications after PED procedures.
  
  
  METHODS
  We recorded patient and aneurysm characteristics, P2Y12 receptor antagonist administered, pre-procedure PRU value with VerifyNow, procedural variables and perioperative thromboembolic and hemorrhagic complications up to postoperative day 30 after PED procedures at our institution during an 8-month period. Perioperative complications were considered major if they caused a permanent disabling neurological deficit or death. Multivariate regression analysis was performed to identify independent predictors of perioperative complications in our cohort.
  
  
  RESULTS
  Forty-four patients underwent 48 PED procedures at our institution during the study period. There were eight thromboembolic and hemorrhagic perioperative complications in our cohort (16.7%), four of which were major (8.3%). A pre-procedure PRU value of <60 or >240 (p=0.02) and a technically difficult procedure (p=0.04) were independent predictors of all perioperative complications. A pre-procedure PRU value of <60 or >240 (p=0.004) and a history of hypertension (p=0.03) were independent predictors of major perioperative complications.
  
  
  CONCLUSIONS
  In our cohort, a pre-procedure PRU value of <60 or >240 was the strongest independent predictor of all and major perioperative thromboembolic and hemorrhagic complications after PED procedures.
authors: Division of Interventional Neuroradiology, Neuroscience Institute, Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
authors: Josser E
authors: JE
authors: Delgado Almandoz
authors: Benjamin M
authors: BM
authors: Crandall
authors: Jill M
authors: JM
authors: Scholz
authors: Jennifer L
authors: JL
authors: Fease
authors: Ruth E
authors: RE
authors: Anderson
authors: Yasha
authors: Y
authors: Kadkhodayan
authors: David E
authors: DE
authors: Tubman
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002533:Cerebral Angiography; D002543:Cerebral Hemorrhage / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics*; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000009:adverse effects*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000235:genetics* / Q000473:pathology / Q000628:therapy*; D007431:Intraoperative Complications / Q000453:epidemiology; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D019990:Perioperative Care; D011237:Predictive Value of Tests; D058921:Purinergic P2Y Receptor Antagonists / Q000494:pharmacology; D058925:Receptors, Purinergic P2Y12 / Q000235:genetics*; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D015607:Stents; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology* / Q000235:genetics*; D016896:Treatment Outcome
chemical_list: D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12
keywords: Aneurysm; Flow Diverter; Hemorrhage; Platelets; Stroke