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Original research
The inhibition rate estimated using VerifyNow can help to predict the thromboembolic risk of coil embolization for unruptured intracranial aneurysms
  1. Young Deok Kim,
  2. O-Ki Kwon,
  3. Seung Pil Ban,
  4. Yu Deok Won,
  5. Jae Seung Bang,
  6. Tackeun Kim,
  7. Si Un Lee,
  8. Hyun Jun Jo,
  9. Chang Wan Oh
  1. Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Bundang-gu, Korea (the Republic of)
  1. Correspondence to Dr O-Ki Kwon, Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam 13620, Korea (the Republic of); meurokwonoki{at}gmail.com

Abstract

Background The role of the inhibition rate of VerifyNow in assessing the thromboembolic risk of coil embolization for unruptured intracranial aneurysms is unclear.

Objective To carry out a retrospective study to determine whether the inhibition rate could provide additional help in predicting thromboembolic events when it was used for patients with a P2Y12 reaction unit (PRU) level of 220 or lower.

Methods Patients who underwent coil embolization for unruptured aneurysms with an appropriate PRU level (PRU 220 or lower) between January 1, 2015 and December 31, 2018 were analyzed. A total of 954 patients with 1020 aneurysms were included in this study. The primary outcome was the thromboembolic events occurring within 30 days after coil embolization. The receiver operating characteristic (ROC) curve and the area under the curve (AUC) were obtained to determine the quantitative predictive ability of the inhibition rate. The optimal cut-off value was derived using the Youden index.

Results Thromboembolic events developed in 11 patients (1.08% of 1020 procedures). The AUC of the ROC curve was 0.83. The optimal cut-off value of the inhibition rate derived using the maximum Youden index was 22.0%. A sensitivity test using a multiple logistic regression analysis demonstrated that the inhibition rate was a significant variable for predicting thromboembolic events.

Conclusions The inhibition rate can be used to determine high thromboembolic risks for patients with PRU levels of 220 or lower. The optimal cut-off value of the inhibition rate was 22.0% when the PRU level was 220 or less.

  • aneurysm
  • intervention
  • coil
  • drug

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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Footnotes

  • Contributors O-KK, SPB, YDK: conception and design of the study. YDK, YDW, HJJ, TK, SUL: acquisition, analysis and interpretation of data. YDK: drafting the manuscript. CWO, O-KK, JSB: critical review of the manuscript, final approval of the version to be published. YDK, O-KK, SPB, YDW, JSB, TK, SUL, HJJ, CWO: agreement to be accountable for all aspects of the study.

  • Funding This study was supported by Seoul National University Bundang Hospital (14-2015-003).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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