title: Prophylactic Antiplatelet Medication in Endovascular Treatment of Intracranial Aneurysms: Low-Dose Prasugrel versus Clopidogrel.
abstract: OBJECTIVE
  Prophylactic antiplatelet medication is beneficial in decreasing thromboembolic complications during endovascular treatment of unruptured intracranial aneurysms. The efficacy may be limited by variability of individual response to antiplatelet medication, especially clopidogrel. We compared the efficacy of 2 antiplatelet medications, low-dose prasugrel and clopidogrel, in patients undergoing endovascular treatment of unruptured aneurysms.
  
  
  METHODS
  From November 2014 to July 2015, 194 patients with a total of 222 unruptured aneurysms underwent endovascular treatment at a single institution. Laboratory and clinical data from the prospectively maintained registry were used in this study. Antiplatelet medication was given the day before endovascular treatment (prasugrel 20 mg or 30 mg or clopidogrel 300 mg). Response to the antiplatelet medication was measured by the VerifyNow system. Periprocedural adverse event rates between the 2 groups were compared.
  
  
  RESULTS
  There were no significant differences in the baseline characteristics of patients and aneurysms between the 2 groups. The P2Y12 reaction unit values were lower (clopidogrel group versus prasugrel group, 242.7 ± 69.8 vs 125.7 ± 79.4;P< .0001) and percentage inhibition values were higher (22.1% ± 19.7% vs 60.2 ± 24.7%;P< .0001) in the prasugrel group. There were no thromboembolic events, but there was 1 procedural bleed in each group, without any clinical consequences.
  
  
  CONCLUSIONS
  The prasugrel group showed more effective and consistent platelet inhibition. We may omit the antiplatelet response assay with the low-dose prasugrel premedication before the endovascular treatment of patients with unruptured aneurysms. Further study is required to determine whether there is benefit of this strategy regarding clinical outcome.
authors.affiliation: From the Departments of Neurosurgery (E.J.H., W.S.C., J.E.K., H.S.K.).
authors.forename: E J
authors.identifier: http://orcid.org/0000-0003-3278-0550
authors.initials: EJ
authors.lastname: Ha
authors.affiliation: From the Departments of Neurosurgery (E.J.H., W.S.C., J.E.K., H.S.K.).
authors.forename: W S
authors.identifier: http://orcid.org/0000-0002-3345-8718
authors.initials: WS
authors.lastname: Cho
authors.affiliation: From the Departments of Neurosurgery (E.J.H., W.S.C., J.E.K., H.S.K.).
authors.forename: J E
authors.identifier: http://orcid.org/0000-0002-6927-3109
authors.initials: JE
authors.lastname: Kim
authors.affiliation: Radiology (Y.D.C., M.H.H.), Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Y D
authors.identifier: http://orcid.org/0000-0002-5293-2761
authors.initials: YD
authors.lastname: Cho
authors.affiliation: Department of Neurosurgery (H.H.C.), Dongguk University Ilsan Hospital, Gyeonggi, Korea.
authors.forename: H H
authors.identifier: http://orcid.org/0000-0003-1170-6829
authors.initials: HH
authors.lastname: Choi
authors.affiliation: Department of Neurosurgery (T.K., J.S.B., G.H., O.K.K., C.W.O.), Seoul National University Bundang Hospital, Gyeonggi, Korea.
authors.forename: T
authors.identifier: http://orcid.org/0000-0002-4375-8095
authors.initials: T
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery (T.K., J.S.B., G.H., O.K.K., C.W.O.), Seoul National University Bundang Hospital, Gyeonggi, Korea.
authors.forename: J S
authors.identifier: http://orcid.org/0000-0001-9543-8758
authors.initials: JS
authors.lastname: Bang
authors.affiliation: Department of Neurosurgery (T.K., J.S.B., G.H., O.K.K., C.W.O.), Seoul National University Bundang Hospital, Gyeonggi, Korea.
authors.forename: G
authors.identifier: http://orcid.org/0000-0002-7405-0487
authors.initials: G
authors.lastname: Hwang
authors.affiliation: Department of Neurosurgery (T.K., J.S.B., G.H., O.K.K., C.W.O.), Seoul National University Bundang Hospital, Gyeonggi, Korea.
authors.forename: O K
authors.identifier: http://orcid.org/0000-0002-7379-9891
authors.initials: OK
authors.lastname: Kwon
authors.affiliation: Department of Neurosurgery (T.K., J.S.B., G.H., O.K.K., C.W.O.), Seoul National University Bundang Hospital, Gyeonggi, Korea.
authors.forename: C W
authors.identifier: http://orcid.org/0000-0001-7311-7072
authors.initials: CW
authors.lastname: Oh
authors.affiliation: Radiology (Y.D.C., M.H.H.), Seoul National University College of Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: M H
authors.identifier: http://orcid.org/0000-0001-5476-3482
authors.initials: MH
authors.lastname: Han
authors.affiliation: From the Departments of Neurosurgery (E.J.H., W.S.C., J.E.K., H.S.K.) hsk4428@yahoo.com.
authors.forename: H S
authors.identifier: http://orcid.org/0000-0002-6957-1907
authors.initials: HS
authors.lastname: Kang