Abstract W MP31: Thrombotic and Hemorrhagic Complications After Pipeline Embolization - A Platelet Aggregation and Transcranial Doppler Study
In this study, we sought to determine the correlation between the pre-treatment platelet aggregation, and the respective occurrence of thrombotic and hemorrhagic complications after pipeline embolization device (PED) for treatment of intracranial aneurysms. In addition, we evaluated the cerebral hemodynamics and the presence of silent emboli after PED placement in some patients utilizing transcranial Doppler (TCD).
Methods: We analyzed the clinical and imaging characteristics of 46 consecutive patients who underwent 48 PED procedures. All patients received double antiplatelet therapy with Clopidogrel 75mg and Aspirin 325mg daily for at least 3 days prior to the planned procedure. Platelet aggregation testing was performed in 41/48 (86%) procedures. Based on the initial ADP % inhibition, patients were divided in 3 groups in the present study: 1) poor responders: <50%, 2) satisfactory responders: 50-75%, and 3) over-responders: > 75%
Results: Hemorrhagic complications requiring escalation of care occurred in 15% (7/48) of all procedures, including 3 patients with symptomatic ICH. 2/3 ICHs occurred in a remote vascular territory in reference to the treated aneurysm, one of which was fatal. Thrombotic complications occurred at a rate of 13% (6/48), of which 3 (9%) were symptomatic. Permanent complication-related morbidity and mortality at 6 months was 4% (2/48).
Of all patients with available platelet aggregation testing (n=41), 13 (31%) were poor Clopidogrel responders. Of those, 6 were switched to an alternative antiplatelet regimen. Thrombotic complications occurred mostly in the poor responders group who had no change in their regimen (27% vs. 4%; p=0.05).
Intracranial hemorrhage occurred entirely in the over-responders group, (0% vs. 14%; p=0.08). None of the TCD demonstrated presence of silent emboli. In addition, 10/11 patients had elevated flow velocities after the PED placement.
1. Pre-treatment Clopidogrel response, measured by ADP % inhibition may predict thrombotic and/or hemorrhagic complications after PED placement.
2. Distal embolization likely occurs mostly during, but not after the procedure as suggested by the TCD data in this study.
Author Disclosures: R. Raychev: None. S. Tateshima: None. F. Vinuela: None. R. Jahan: None. N. Gonzalez: None. V. Szeder: None. A. Bagude: None. A. Konstas: None. G. Duckwiler: None.
- © 2014 by American Heart Association, Inc.