Abstract 3708: Safety and Efficacy of Antiplatelet Monotherapy (clopidogrel) in Stent Assisted Elective Coil Embolization of Cerebral Aneurysms
BACKGROUND AND PURPOSE: Thromboembolic events are the most common complication seen in elective coil embolization of cerebral aneurysms. Previous studies have shown that administration of oral clopidogrel and/or aspirin may lower the thromboembolic complication rate but little data exists regarding clinical outcome with the use of antiplatelet monotherapy in stent assisted elective aneurysm coil embolization.
Objectives: To assess the safety and efficacy of antiplatelet monotherapy (clopidogrel) in elective stent assisted coil embolization of cerebral aneurysms
MATERIALS AND METHODS: Retrospective chart review was performed in 94 consecutive patients who underwent endovascular treatments for elective coil embolization of cerebral aneurysms between 2008-2010. Thirty patients were included in this study who met the inclusion criteria of stent assisted coil embolization. All these patients received 75mg clopidogrel for one week prior to the procedure. Clopidogrel was continued post procedure for six to eight weeks. Primary outcome measure was peri-procedure and post-procedure symptomatic thromboembolic complications.
RESULTS The study included 23 females and 7 males with mean age 52.6 years.Twenty (66.7%) patients had anterior circulation aneurysms and 10 (33.3%) patients had posterior circulation aneurysms. Twenty (66.7%) patients were treated with Neuroform, 9 (30%) patients with Enterprise stent and 1 (3.3%) patient was treated with both Neuroform and Enterprise stent assisted coil embolization. One (3.3%) patient had an iatrogenic flow limiting vertebral artery dissection during embolization of vertebrobasilar artery aneurysm with no clinical deficit. The patient’s vertebral artery dissection was treated with 2 Wingspan stents and 1 Medtronic driver stents. Symptomatic thromboembolic complication was seen in 1 patient (3.3%) at discharge. The patient had a giant basilar tip aneurysm which was treated with stent assisted coil embolization. Postprocedure the patient had a right facial palsy with gaze deviation. The MRI was consistent with acute posterior circulation stroke. The patient was discharged home with a modified Rankin Scale <2. Follow up at six to eight weeks post procedure clinical data was available for 21 patients (73.3%). No delayed thromboembolic complication was observed in these patients at follow up visit.
CONCLUSION: Oral clopidogrel is safe and efficacious as an antiplatelet monotherapy during elective stent assisted coil embolization. Further multicenter prospective trials are warranted to evaluate safety and efficacy of clopidogrel as a monotherapy for elective stent assisted coil embolization.
- © 2012 by American Heart Association, Inc.