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Ge H, Yang H, Ren H, Li W, Lv X, Jin H, Liu D, Liu X, He H, Miao Z, Li Y. Association of Thrombelastographic Parameters with Complications in Patients with Intracranial Aneurysm After Stent Placement. World Neurosurg 2019; 127:e30-e38. [PMID: 30790737 DOI: 10.1016/j.wneu.2019.02.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2018] [Accepted: 02/04/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE A prospective trial was conducted to investigate the platelet function and association between thrombelastographic (TEG) parameters and embolic or hemorrhagic complications in patients with intracranial aneurysm undergoing stent treatment. METHODS Between September 2013 and June 2016, we prospectively recruited patients with intracranial aneurysm who were treated with stent-assisted coiling. TEG parameters were used to assess the platelet function before stenting procedures. The primary study end point was the onset of ischemic stroke, transient ischemic attack, or silent ischemic events in the territory of the stented artery within 6 months after the procedure. The secondary end point was assessed by bleeding events. RESULTS Four hundred and thirty-one patients with 453 intracranial aneurysms were enrolled. A total of 519 neurovascular stents were implanted. During the follow-up, a total of 70 primary end points (16.2%) and 59 secondary end points (13.7%) were detected. Thromboembolic complications such as symptomatic and slient ischemic complications were more frequently observed in patients with large aneurysms (>10 mm, P = 0.01), lower adenosine diphosphate (ADP) inhibition rate (P < 0.0001), and higher ADP-induced platelet-fibrin clot strength (maximum amplitude of adenosine diphosphate [MA-ADP]) (P < 0.0001). Besides, based on multivariate analysis, a higher ADP inhibition ratio was identified as a significant independent predictor of subsequent bleeding events (P < 0.0001). According to the receiver operating characteristic curve analysis, the safe range of the ADP inhibition ratio and MA-ADP of the TEG analysis were identified as 29.45%-55.4% and <46.15, respectively. CONCLUSIONS The ADP inhibition ratio and MA-ADP of TEG analysis were associated with subsequent cerebral ischemic events and intracranial or extracranial bleeding events in patients with intracranial aneurysm after stent treatment.
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Affiliation(s)
- Huijian Ge
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Hongchao Yang
- Department of Interventional Neuroradiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Hui Ren
- Laboratory Diagnosis Center, Beijing Luhe Hospital, Capital Medical University, Beijing, China
| | - Wei Li
- Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China; Neurosurgery Department, The Second Affiliated Hospital of Xingtai Medical College, Hebei, China
| | - Xianli Lv
- Neurosurgery Department, Beijing Tsinghua Changgung Hospital, Tsinghua University, Beijing, China
| | - Hengwei Jin
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Dong Liu
- Department of Neurosurgery, Sanbo Brain Hospital, Capital Medical University, Beijing, China
| | - Xinke Liu
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Hongwei He
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China
| | - Zhongrong Miao
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Youxiang Li
- Department of Interventional Neuroradiology, Beijing Neurosurgical Institute and Beijing Tiantan Hospital, Capital Medical University, Beijing, China; Beijing Engineering Research Center for Interventional Neuroradiology, Beijing, China.
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