TY - JOUR T1 - Platelet function inhibitors and platelet function testing in neurointerventional procedures JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg SP - 567 LP - 577 DO - 10.1136/neurintsurg-2014-011357 VL - 6 IS - 8 AU - Chirag D Gandhi AU - Ketan R Bulsara AU - Johanna Fifi AU - Tareq Kass-Hout AU - Ryan A Grant AU - Josser E Delgado Almandoz AU - Joey English AU - Philip M Meyers AU - Todd Abruzzo AU - Charles J Prestigiacomo AU - Ciaran James Powers AU - Seon-Kyu Lee AU - Barbara Albani AU - Huy M Do AU - Clifford J Eskey AU - Athos Patsalides AU - Steven Hetts AU - M Shazam Hussain AU - Sameer A Ansari AU - Joshua A Hirsch AU - Michael Kelly AU - Peter Rasmussen AU - William Mack AU - G Lee Pride AU - Michael J Alexander AU - Mahesh V Jayaraman Y1 - 2014/10/01 UR - http://jnis.bmj.com/content/6/8/567.abstract N2 - Over the past decade there has been a growing use of intracranial stents for the treatment of both ischemic and hemorrhagic cerebrovascular disease, including stents to assist in the remodeling of the neck of aneurysms as well as the use of flow diverting devices for aneurysm treatment. With this increase in stent usage has come a growing need for the neurointerventional (NI) community to understand the pharmacology of medications used for modifying platelet function, as well as the testing methodologies available. Platelet function testing in NI procedures remains controversial. While pre-procedural antiplatelet assays might lead to a reduced rate of thromboembolic complications, little evidence exists to support this as a standard of care practice. Despite the routine use of dual antiplatelet therapy (DAT) with aspirin and a P2Y12 receptor antagonist (such as clopidogrel, prasugrel, or ticagrelor) in most neuroembolization procedures necessitating intraluminal reconstruction devices, thromboembolic complications are still encountered.1–3 Moreover, DAT carries the risk of hemorrhagic complications, with intracerebral hemorrhage (ICH) being the most potentially devastating.4 ,5 Light transmission aggregometry (LTA) is the gold standard to test for platelet reactivity, but it is usually expensive and may not be easily obtainable at many centers. This has led to the development of point-of-care assays, such as the VerifyNow (Accumetrics, San Diego, California, USA), which correlates strongly with LTA and can reliably measure the degree of P2Y12 receptor inhibition.6–9 VerifyNow results are reported in P2Y12 reaction units (PRUs), with a lower PRU value corresponding to a higher level of P2Y12 receptor inhibition and, presumably, a lower probability of platelet aggregation, and a higher PRU value corresponding to a lower level of P2Y12 receptor inhibition and, hence, a higher chance of platelet activation and aggregation. While aspirin resistance is perhaps less common, clopidogrel resistance may be more challenging as … ER -