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Clinical neurology
Original research
Association of thrombelastographic parameters with post-stenting ischemic events
  1. Bo Wang1,
  2. Xiao-Qing Li1,2,
  3. Ning Ma1,
  4. Dapeng Mo1,
  5. Feng Gao1,
  6. Xuan Sun1,
  7. Xiaotong Xu1,
  8. Lian Liu1,
  9. Ligang Song,
  10. Xin-Gang Li3,
  11. Zhigang Zhao3,
  12. Xingquan Zhao4,
  13. Zhong-Rong Miao1
  1. 1Department of Interventional Neuroradiology, Beijing Tian Tan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (NCRC-ND); Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
  2. 2Department of Neurology, Shaanxi Provincial People's Hospital, Xi'an, China
  3. 3Department of Pharmacy, Beijing Tian Tan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (NCRC-ND); Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
  4. 4Department of Neurology, Beijing Tian Tan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (NCRC-ND); Center of Stroke, Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
  1. Correspondence to Dr Zhong-Rong Miao, Department of Interventional Neuroradiology, Beijing Tian Tan Hospital, Capital Medical University, China National Clinical Research Center for Neurological Diseases, Center of Stroke, Beijing Institute for Brain Disorders, Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China; zhongrongm{at}163.com

Abstract

Background and purpose Thrombelastography (TEG) is widely used for the measurement of platelet function. However, few studies have investigated the TEG parameters in patients receiving extracranial or intracranial artery stenting for ischemic cerebrovascular disease. This study sought to describe the association of TEG parameters before the procedure with post-procedural ischemic events after extracranial or intracranial artery stenting.

Methods Patients in whom stenting was performed for extracranial or intracranial artery stenosis (70–99%) were recruited into the study. Blood samples were obtained for TEG to assess platelet function before stenting. The primary endpoint was ischemic stroke or transient ischemic attack in the territory of the stented artery.

Results A total of 218 patients were included in the study. During a mean follow-up period of 132 days (range 98–226 days), 18 (8.3%) primary endpoint events were recorded. Compared with patients without ischemic events, the ADP-induced platelet-fibrin clot strength (MAADP) was significantly higher (41.57±15.10 vs 33.50±13.86, p=0.020) and the ADP inhibition rate (ADP%) was significantly lower in patients with ischemic events (39.54±23.15 vs 55.29±24.43, p=0.009). Multivariate analysis identified MAADP and ADP% as significant independent predictors of subsequent ischemic events with HRs of 1.036 and 0.965, respectively. From receiver operating characteristic curve analysis, MAADP >49.95 mm had the best predictive value of ischemic events.

Conclusions Our study suggests that TEG parameters MAADP and ADP% are associated with subsequent ischemic events in patients with extracranial or intracranial stents.

Clinical trial number NCT01925872.

  • Angioplasty
  • Atherosclerosis
  • Platelets
  • Stenosis
  • Stent

https://doi.org/10.1136/neurintsurg-2015-011687

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    Footnotes

    • BW and X-QL contributed equally to this article.

    • ZZ, XZ, and Z-RM contributed equally to this article.

    • Contributors XZ, Z-RM: conceived and designed the experiments. BW, X-QL, NM, DM, FG, XS, XX, LL, LS: performed the experiments. BW, X-QL, NM, Z-RM: analyzed the data. BW, X-QL, NM, DM, FG, XS, XX, LL, LS, X-GL, ZZ, XZ, Z-RM: contributed reagents/materials/analysis tools. BW, X-QL, NM: wrote the paper. ZZ, XZ, Z-RM: supervised the quality of the study.

    • Funding Beijing High-level personnel funds, Contract grant number: 2013-2-19 to Z-RM; National Natural Science Foundation of China, Contract grant number: 81371290 to Z-RM; Beijing Municipal Science and Technology Commission, Contract grant number: D111107003111007 to X-QZ; Clinical and Basic Medical Cooperation Project of Capital Medical University, Contract grant number: 13JL40 to NM.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Ethics approval The study was approved by the institutional ethics committee at Beijing Tian Tan Hospital.

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