TY - JOUR T1 - Tailored antiplatelet therapy in stent assisted coiling for unruptured aneurysms: a nationwide registry study JF - Journal of NeuroInterventional Surgery JO - J NeuroIntervent Surg DO - 10.1136/jnis-2022-019571 SP - jnis-2022-019571 AU - Jun Seok Koh AU - Gyojun Hwang AU - Jung Cheol Park AU - Chang-Young Lee AU - Joonho Chung AU - Sang-Weon Lee AU - Hyon-Jo Kwon AU - Seong-Rim Kim AU - Dong-Hun Kang AU - Soon Chan Kwon AU - Sung-Tae Kim AU - Chul Hoon Chang AU - Dong-Kyu Jang AU - Jae Hyung Choi AU - Young Woo Kim AU - Bum-Tae Kim AU - Byoung Gook Shin AU - Seung Hoon You AU - Seung Young Chung AU - Junkyeung Ko AU - Tae Gon Kim AU - Seok-Mann Yoon AU - Jong Young Lee AU - Hyun Park AU - Jung Hyun Park AU - Jae-Hoon Cho AU - Hae-Won Koo AU - Jae Hoon Sung AU - Jinnie Rhee AU - Ho Gyun Shin A2 - , Y1 - 2023/01/03 UR - http://jnis.bmj.com/content/early/2023/01/03/jnis-2022-019571.abstract N2 - Background Antiplatelet therapy, where regimens are tailored based on platelet function testing, has been introduced into neurointerventional surgery. This nationwide registry study evaluated the effect and safety of tailored antiplatelet therapy in stent assisted coiling for unruptured aneurysms compared with conventional therapy using a standard regimen.Methods This study enrolled 1686 patients in 44 participating centers who received stent assisted coiling for unruptured aneurysms between January 1, 2019 and December 31, 2019. The standard regimen (aspirin and clopidogrel) was used for all patients in the conventional group (924, 19 centers). The regimen was selected based on platelet function testing (standard regimen for clopidogrel responders; adding cilostazol or replacing clopidogrel with other thienopyridines (ticlopidine, prasugrel, or ticagrelor) for clopidogrel non-responders) in the tailored group (762, 25 centers). The primary outcome was thromboembolic events. Secondary outcomes were bleeding and poor outcomes (increase in modified Rankin Scale score). Outcomes within 30 days after coiling were compared using logistic regression analysis.Results The thromboembolic event rate was lower in the tailored group than in the conventional group (30/762 (3.9%) vs 63/924 (6.8%), adjusted OR 0.560, 95% CI 0.359 to 0.875, P=0.001). The bleeding event rate was not different between the study groups (62/762 (8.1%) vs 73/924 (7.9%), adjusted OR 0.790, 95% CI 0.469 to 1.331, P=0.376). Poor outcomes were less frequent in the tailored group (12/762 (1.6%) vs 34 (3.7%), adjusted OR 0.252, 95% CI 0.112 to 0.568, P=0.001).Conclusion Tailored antiplatelet therapy in stent assisted coiling for unruptured aneurysms reduced thromboembolic events and poor outcomes without increasing bleeding.Data are available upon reasonable request. Permission from National Evidence based healthcare Collaborating Agency and Korean NeuroEndovascular Society is required. ER -