Purpose Antiplatelet management is essential in neuroendovascular treatment, especially with intracranial stent deployment, for thromboembolic complication reduction. There are few articles which described the use of light transmission aggregometry (LTA) as a platelet function test prior to deployment of intracranial stent. The aim of this study was to evaluate the usefulness of strict antiplatelet management in patients with stent assisted coil embolization.

Method A total of 372 patients with intracranial aneurysms were treated with endovascular procedure from July 2015 to March 2018. During the period, 119 patients underwent stent-assisted coil embolization. All patients were measured platelet function test before procedure. Platelet function test was performed using LTA measuring adenosine diphosphate (ADP). We retrospectively analyzed thromboembolic complication based on two protocols (stages) of antiplatelet management for that period. In early stage, the patients were taken regular double antiplatelet therapy (aspirin 100 mg and clopidogrel 75 mg, daily) seven days before the procedure. In the late stage, we employed strict antiplatelet management described as follows: if ADP value is less than 60, additional clopidogrel 75 mg was administered in addition to the regular double antiplatelet therapy. Thromboembolic complications occurring from the date of the procedure until discharge were evaluated.

Results In the early stage (July 2015 to August 2016), three thromboembolic complications were occurred out of 35 patients (8.6%). Patients with complications had significantly higher average ADP value than those without complication (60.7 versus 45.6; p=0.018). A cut-off value of ADP was 62 (AUC 0.807, Sensitivity 0.67, Specificity 0.93). In the late stage (August 2016 to March 2018), CLP boosting was conducted in nine patients out of 84 patients (10.7%). The rate of thromboembolic complication was significantly lower in late stage than that in the early stage (1.2% versus 8.6%; p=0.04).

Conclusion Strict antiplatelet management using platelet aggregation test may reduce thromboembolic complication in patients with stent assisted coil embolization.

Disclosures I. Kan: None. T. Ishibashi: None. I. Yuki: None. K. Sakuta: None. T. Kodama: None. S. Kaku: None. N. Kato: None. K. Nishimura: None. K. Aoki: None. Y. Murayama: None.