title: Contribution of whole platelet aggregometry to the endovascular management of unruptured aneurysms: an institutional experience.
abstract: BACKGROUND
  Stent-assisted coiling of intracranial aneurysms is an efficient alternative treatment to surgical clipping but requires prolonged antiplatelet therapy. Some patients are non-responsive to aspirin and/or clopidogrel.
  
  
  OBJECTIVE
  To analyze the implications of this assessment using the 'whole blood aggregometry (WBA) by impedance' technique.
  
  
  METHODS
  The Southwestern Tertiary Aneurysm Registry was reviewed between 2002 and 2012 for patients with unruptured aneurysms treated with stent-assisted coiling. The study population was divided into patients who were tested preoperatively for platelet responsiveness to aspirin and clopidogrel ('tested' patients) and those who were not ('non-tested'). Where necessary, tested patients received additional doses of antiplatelet drugs to achieve adequate platelet inhibition. Endpoints included the incidence of non-responsiveness, the rates of thrombotic and hemorrhagic complications, and the rates of permanent morbidity and mortality.
  
  
  RESULTS
  A total of 266 patients fulfilled our selection criteria: 114 non-tested patients who underwent 121 procedures, and 152 tested patients who underwent 171 procedures. The two groups did not vary significantly in patient age, gender, and aneurysms location. Aspirin non-responsiveness was detected in 3 patients (1.75%) and clopidogrel non-responsiveness in 21 patients (12.3%). Non-tested patients had an 11.6% rate of thrombotic complications with a 4.1% permanent morbidity or mortality rate versus 2.3% and 0.6% in tested patients (p=0.0013). The incidence of hemorrhagic complications was similar between the two groups.
  
  
  CONCLUSIONS
  Preoperative platelet inhibition testing using WBA can be useful to assess and correct antiaggregant non-responsiveness, and may reduce postoperative mortality and permanent morbidity.
authors.affiliation: Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA.
authors.forename: S G
authors.initials: SG
authors.lastname: Aoun
authors.affiliation: Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA.
authors.forename: B G
authors.initials: BG
authors.lastname: Welch
authors.affiliation: Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA.
authors.forename: L G
authors.initials: LG
authors.lastname: Pride
authors.affiliation: Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA.
authors.forename: J
authors.initials: J
authors.lastname: White
authors.affiliation: Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA.
authors.forename: R
authors.initials: R
authors.lastname: Novakovic
authors.affiliation: Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA.
authors.forename: K
authors.initials: K
authors.lastname: Hoes
authors.affiliation: Departments of Neurosurgery, Radiology, and Pathology, The University of Texas Southwestern, Dallas, Texas, USA.
authors.forename: R
authors.initials: R
authors.lastname: Sarode
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage; D001792:Blood Platelets / Q000187:drug effects* / Q000502:physiology; D000077144:Clopidogrel; D019468:Disease Management; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D006801:Humans; D002532:Intracranial Aneurysm / Q000097:blood / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010974:Platelet Aggregation / Q000187:drug effects* / Q000502:physiology; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D012042:Registries; D012189:Retrospective Studies; D015607:Stents / Q000009:adverse effects; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin
keywords: Aneurysm; Angiography; Complication; Stent; Stroke