stents

INTRODUCTION: The measurement of platelet inhibition (PI) level may be useful in quantifying the risk of thromboembolic complication in subjects undergoing endovascular treatment using implantable materials. We studied the predictability of the VerifyNow point-of-care assay in a large sample of consecutive neurointerventional procedures. METHODS: The percentage of P2Y12-inhibition was systematically measured in a total of 271 procedures (245 patients). The incidence of poor response and adverse events within the first 48 hours were recorded. RESULTS: The overall occurrence of poor response after a single loading-dose of clopidogrel of 300 mg was 61.3 % using a cut-off of 40 % and 43.9 % using a cut-off of 20 %. In the analysis of the incidence of adverse events by P2Y12-inhibition grouping, a significant association was observed between thromboembolic events and low response, with an overall incidence of 10.2 % (cut-off of 40 %) and 11.8 % (cut-off of 20 %). The assessment of predictability using different cut-offs showed that more than 90 % of thromboembolic events would be in the group of poor responders using a 40 % cut-off and more than 75 % using 20 %. CONCLUSION: The use of the VerifyNow assay in the neurointerventional context seems a valuable tool in the early detection of individuals at risk of peri-operative thromboembolic adverse events.

This review summarises the reported clinical experience with flow diverters for the reconstruction of the parent artery of intracranial aneurysms, since their introduction 5 years ago. Over this period, the literature has documented treatment concepts and initial results. Safety concerns, some of which have proved unwarranted, have limited the use of these devices to the treatment of aneurysms which were likely to fail or had failed to be effectively treated by endosaccular coil embolisation. The emerging data now allows the risks of complications specific to this technology to be quantified and the emerging consensus on its efficacy has extended its use to include aneurysms suitable for conventional coil embolisation, in some centres. The need for antiplatelet prophylaxis will probably limit its use to anatomically complex and dissecting aneurysms in patients after spontaneous intracranial haemorrhage. This extending role highlights the need for systematic retrospective analysis of existing large case series and randomised comparative studies.