Neurointerventional Stenting and Antiplatelet Function Testing: To Do or Not to Do?
OBJECTIVE
Platelet function testing in neurointerventional (NI) procedures is still controversial. We compared the clinical outcomes between antiplatelet responders and nonresponders based on the results of the VerifyNow (VN) testing method.


METHODS
This is a retrospective single-center analysis of all consecutive patients who underwent NI stenting procedures from January 2007 through July 2013 and had documented preprocedural aspirin (ASA) and clopidogrel VN assays. Patients were divided into two groups based on their responsiveness to antiplatelet. Baseline characteristics, good functional outcome measured by the modified Rankin Scale (mRS) at 90 days, combined procedural complication rate defined as postprocedural stroke, in-stent thrombosis, and intraoperative rupture were compared between the two groups.


RESULTS
Our cohort included 37 patients: 26 were in the responder group (RG) and 11 were in the nonresponder group (NRG). Baseline characteristics were similar between the two groups. Even though the combined complication rate was similar between the two groups [NRG: 2/11 (18%) vs. RG: 2/26 (7%); p = 0.33], there was a trend for a higher rate of good functional outcome (90-day mRS: 0-2) in the RG (22/22, 100%) as compared to the NRG (8/10, 80%) (p = 0.0907).


CONCLUSIONS
Overall, utilizing the VN antiplatelet function testing did not significantly change the clinical outcome after the NI procedures. Larger randomized trials are warranted to provide a better understanding of the utility of the antiplatelet testing in NI stenting procedures.
Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA.
Tareq
T
Kass-Hout
Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA.
Yazan J
YJ
Alderazi
Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA.
Krishna
K
Amuluru
Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA.
Peter
P
Jin
Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA.
Carlos
C
Ayala
Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA ; Department of Neurology, Rutgers University School of Medicine, Newark, N.J., USA ; Department of Radiology, Rutgers University School of Medicine, Newark, N.J., USA.
Charles
C
Prestigiacomo
Department of Neurosurgery and Neuroscience, Rutgers University School of Medicine, Newark, N.J., USA ; Department of Neurology, Rutgers University School of Medicine, Newark, N.J., USA ; Department of Radiology, Rutgers University School of Medicine, Newark, N.J., USA.
Chirag D
CD
Gandhi
Antiplatelet therapy; Neurointerventional procedures; Thrombo-embolic event; VerifyNow assay