Preoperative Light Transmission Aggregometry Values Predict for Thromboembolic Complications After Stent-Assisted Coil Embolization

Issei Kan; Toshihiro Ishibashi; Kenichi Sakuta; Soichiro Fujimura; Ichiro Yuki; Shogo Kaku; Tomonobu Kodama; Naoki Kato; Kengo Nishimura; Ken Aoki; Yuichi Sasaki; Kostadin Karagiozov; Yuichi Murayama

doi:10.1016/j.wneu.2019.10.179

Preoperative Light Transmission Aggregometry Values Predict for Thromboembolic Complications After Stent-Assisted Coil Embolization

World Neurosurg. 2020 Feb:134:e731-e738. doi: 10.1016/j.wneu.2019.10.179. Epub 2019 Nov 5.

Authors

Affiliations

¹ Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan. Electronic address: isseikan@gmail.com.
² Department of Neurosurgery, Jikei University Hospital, Tokyo, Japan.
³ Department of Neurology, Jikei University Hospital, Tokyo, Japan.
⁴ Department of Innovation for Medical Information Technology, Jikei University School of Medicine, Tokyo, Japan; Graduate School of Mechanical Engineering, Tokyo University of Science, Tokyo, Japan.

PMID: 31704360
DOI: 10.1016/j.wneu.2019.10.179

Abstract

Objective: Risk control of thromboembolic complications (TECs) during stent-assisted coil embolization (SACE) for unruptured intracranial aneurysms (UIAs) is crucial for satisfactory treatment outcomes. We retrospectively evaluated the data from our cohort of SACE for UIAs to analyze the role of anatomical, clinical, and stent type-related factors to determine the optimal preoperative values of light transmission aggregometry (LTA) for TEC prevention.

Methods: From July 2015 to May 2018, we retrospectively analyzed the data from 132 patients with SACE-treated UIAs at our hospital. Data regarding the aneurysm location, maximum diameter, stent type used, preoperative LTA value, and ischemic and hemorrhagic complications were collected. Aspirin 100 mg and clopidogrel 75 mg were started 7 days before surgery, with a "boost" dose (an additional 75 mg of clopidogrel for an LTA value >60%) added after August 2016 to address clopidogrel resistance. After multivariate analysis, we developed our original combined parameter termed the thromboembolic predictor (TEP). Receiver operating characteristic (ROC) analysis for TEP and each significant variable was performed.

Results: TECs were confirmed in 5 of the 132 patients (3.8%) and hemorrhagic complications in 9 of the 132 patients (6.8%). From the multivariate analysis results, the LTA value and maximum diameter were chosen as significant variables and included in the TEP. ROC analysis of the LTA value revealed a sensitivity and specificity of 0.866 and 0.600, respectively (area under the curve, 0.747), with a cutoff of 62%. TEP permitted the establishment of an optimal LTA value according to the aneurysm maximum diameter to predict for TECs. The complication rate for the Neuroform EZ, Enterprise, Neuroform Atlas, and LVIS stents was 2.9%, 10.5%, 1.4%, and 14.3%, respectively.

Conclusions: The preoperative LTA value contributes to the prediction of TECs after SACE for UIAs. The TEP (relating the LTA cutoff to aneurysm size) allows for improved antiplatelet therapy adjustment before SACE to reduce TECs.

Keywords: Antiplatelet therapy; Light transmission aggregometry; Stent-assisted coil embolization.

MeSH terms

Aspirin / therapeutic use
Clopidogrel / therapeutic use
Embolization, Therapeutic*
Endovascular Procedures
Female
Hematoma / epidemiology
Hemorrhage / epidemiology
Humans
Intracranial Aneurysm / therapy*
Male
Middle Aged
Platelet Aggregation Inhibitors / therapeutic use*
Platelet Aggregation*
Platelet Function Tests
Retrospective Studies
Risk Assessment
Stents*
Thromboembolism / epidemiology*

Substances

Platelet Aggregation Inhibitors
Clopidogrel
Aspirin