P2Y12 hyporesponse (PRU>200) is not associated with increased thromboembolic complications in anterior circulation Pipeline.
BACKGROUND
Recent reports suggest that thromboembolic complications are associated with Pipeline embolization device (PED) placement cluster in P2Y12 hyporesponders.


OBJECTIVE
To evaluate the role of P2Y12 hyporesponse in PED placement by retrospectively reviewing a single-center series of patients.


METHODS
We retrospectively reviewed an institutional review board-approved database of patients with an aneurysm at a single institution and identified all patients with a measured P2Y12 reaction unit (PRU)>200 who had undergone anterior circulation PED placement. Events such as transient ischemic attack, stroke, and hemorrhage were identified as well as demographic and procedural details.


RESULTS
Fifty-two patients with a PRU >200 had undergone anterior circulation PED placement. Four patients had prior subarachnoid hemorrhage (SAH) (8%) and 11 aneurysms (21%) had been previously treated. The average aneurysm size was 7.6 mm (±6.2). PED thrombosis occurred intraprocedurally in three patients, none of whom developed neurological deficits after abciximab administration. Treatment of all patients was successful and 48 procedures (92%) had no complications. One patient had a major stroke (2%) with permanent hemiparesis. There were three minor complications (6%): one minor stroke with a visual field cut, one 10 cc intracranial hemorrhage with transient left lower extremity weakness, and one transient neurological deficit not verified by imaging. No deaths or cases of SAH occurred.


CONCLUSIONS
P2Y12 hyporesponse (PRU>200) is not associated with increased periprocedural complications in a contemporary series of patients undergoing anterior circulation PED placement. Titration of antiplatelet medications to P2Y12 >200 remains unindicated and may increase the risk of hemorrhagic complications.
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Matthew T
MT
Bender
Department of Neurosurgery, University of California Irvine School of Medicine, Irvine, California, USA.
Li-Mei
LM
Lin
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Geoffrey P
GP
Colby
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Daniel
D
Lubelski
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Judy
J
Huang
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Rafael J
RJ
Tamargo
Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Alexander L
AL
Coon
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020520:Brain Infarction / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy; D015331:Cohort Studies; D004621:Embolization, Therapeutic / Q000009:adverse effects / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood / Q000000981:diagnostic imaging / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D011446:Prospective Studies; D058925:Receptors, Purinergic P2Y12 / Q000097:blood*; D012189:Retrospective Studies; D020521:Stroke / Q000097:blood / Q000000981:diagnostic imaging / Q000209:etiology; D013923:Thromboembolism / Q000097:blood* / Q000000981:diagnostic imaging* / Q000209:etiology; D016896:Treatment Outcome
C548576:P2RY12 protein, human; D010975:Platelet Aggregation Inhibitors; D058925:Receptors, Purinergic P2Y12
Aneurysm; Flow Diverter