title: Association between Postprocedural Infarction and Antiplatelet Drug Resistance after Coiling for Unruptured Intracranial Aneurysms.
abstract: Procedure-related thromboembolism is a major limitation of coil embolization, but the relationship between thromboembolic infarction and antiplatelet resistance is poorly understood. The purpose of this study was to verify the association between immediate postprocedural thromboembolic infarction and antiplatelet drug resistance after endovascular coil embolization for unruptured intracranial aneurysm.
  
  
  
  This study included 338 aneurysms between October 2012 and March 2015. All patients underwent postprocedural MR imaging within 48 hours after endovascular coil embolization. Antiplatelet drug resistance was checked a day before the procedure by using the VerifyNow system. Abnormal antiplatelet response was defined as >550 aspirin response units and >240 P2Y12 receptor reaction units. In addition, we explored the optimal cutoff values of aspirin response units and P2Y12 receptor reaction units. The primary outcome was radiologic infarction based on postprocedural MR imaging.
  
  
  
  Among 338 unruptured intracranial aneurysms, 134 (39.6%) showed diffusion-positive lesions on postprocedural MR imaging, and 32 (9.5%) and 105 (31.1%) had abnormal aspirin response unit and P2Y12 receptor reaction unit values, respectively. Radiologic infarction was associated with advanced age (65 years and older, P = .024) only with defined abnormal antiplatelet response (aspirin response units ≥ 550, P2Y12 receptor reaction units ≥ 240). P2Y12 receptor reaction unit values in the top 10th percentile (>294) were associated with radiologic infarction (P = .003). With this cutoff value, age (adjusted odds ratio, 2.29; 95% confidence interval, 1.28-4.08), P2Y12 receptor reaction units (>294; OR, 3.43; 95% CI, 1.53-7.71), and hyperlipidemia (OR, 2.05; 95% CI, 1.04-4.02) were associated with radiologic infarction in multivariate analysis.
  
  
  
  Radiologic infarction after coiling for unruptured aneurysm was closely associated with age. Only very high P2Y12 receptor reaction unit values (>294) predicted postprocedural infarction. Further controlled studies are needed to determine the precise cutoff values, which could provide information regarding the optimal antiplatelet regimen for aneurysm coiling.
authors.affiliation: From the Departments of Neurosurgery (M.S.K., J.Y.Y., J.S.K., S.C.H.).
authors.forename: M S
authors.identifier: 0000-0002-8901-7241
authors.initials: MS
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery (K.I.J.), Hana General Hospital, Cheongju, Korea.
authors.forename: K I
authors.identifier: 0000-0001-7585-1916
authors.initials: KI
authors.lastname: Jo
authors.affiliation: From the Departments of Neurosurgery (M.S.K., J.Y.Y., J.S.K., S.C.H.).
authors.forename: J Y
authors.identifier: 0000-0003-4603-8103
authors.initials: JY
authors.lastname: Yeon
authors.affiliation: From the Departments of Neurosurgery (M.S.K., J.Y.Y., J.S.K., S.C.H.).
authors.forename: J S
authors.identifier: 0000-0002-2872-2916
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Radiology (K.H.K., P.J.), Division of Interventional Neuroradiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: K H
authors.identifier: 0000-0002-2104-8367
authors.initials: KH
authors.lastname: Kim
authors.affiliation: Radiology (K.H.K., P.J.), Division of Interventional Neuroradiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: P
authors.identifier: 0000-0002-8642-1791
authors.initials: P
authors.lastname: Jeon
authors.affiliation: From the Departments of Neurosurgery (M.S.K., J.Y.Y., J.S.K., S.C.H.) nsschong@skku.edu.
authors.forename: S C
authors.identifier: 0000-0002-9064-5050
authors.initials: SC
authors.lastname: Hong
mesh_terms: D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D002544:Cerebral Infarction / Q000150:complications / Q000453:epidemiology*; D004351:Drug Resistance; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010979:Platelet Function Tests; D011183:Postoperative Complications / Q000453:epidemiology*; D058921:Purinergic P2Y Receptor Antagonists / Q000627:therapeutic use; D058925:Receptors, Purinergic P2Y12; D012189:Retrospective Studies; D013923:Thromboembolism / Q000453:epidemiology* / Q000209:etiology
chemical_list: D010975:Platelet Aggregation Inhibitors; D058921:Purinergic P2Y Receptor Antagonists; D058925:Receptors, Purinergic P2Y12; D001241:Aspirin