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Thromboelastography 6s for assessment of platelet function during coil embolization of unruptured intracranial aneurysms

      Abstract

      Objectives

      Methods for assessing platelet function in patients with neurovascular disease remain controversial and poorly studied. This study aimed to assess associations between thromboelastography 6s (TEG6s) measurements and postoperative ischemic complications in patients with unruptured intracranial aneurysms (UIAs) treated by coil embolization.

      Methods

      Eighty-four patients with UIAs taking a combined aspirin and clopidogrel protocol were retrospectively reviewed from January 2021 to May 2022. Blood samples were obtained for TEG6s to assess platelet function on the day of coil embolization. To identify acute ischemic complications, diffusion-weighted imaging (DWI) was performed within 24 h after coil embolization. Multivariate logistic regression analysis was conducted to identify potential risk factors for postoperative positive DWI (DWI (+)) lesions.

      Results

      Forty-three of the 84 patients (51%) with DWI (+) lesions were identified. Compared with patients without DWI (+) lesions, Adenosine diphosphate (ADP)-induced platelet-fibrin clot strength (MAADP) was significantly higher (53.6 mm [Interquartile range (IQR): 48.3–58.3 mm] vs 46.7 mm [IQR: 36.8–52.2 mm]; p=0.001) and ADP inhibition rate (ADP%) was significantly lower (19% [IQR: 11–31%] vs 31% [IQR: 21–44%]; p=0.001) in DWI (+) patients. Multivariate analysis identified MAADP, ADP%, and procedure time as significant independent predictors of subsequent DWI (+) lesions (odds ratios: 1.07, 0.96, and 1.02, respectively). Based on receiver operating characteristic curve analysis, MAADP >50.9 mm and ADP% <28.8% were associated with postoperative DWI (+) lesions in patients undergoing coil embolization for UIAs.

      Conclusions

      MAADP and ADP% as assessed by TEG6s can offer reliable parameters to predict postoperative ischemic complications after coil embolization of UIAs. Lower MAADP values and higher ADP% may decrease the risk of postoperative ischemic complications.

      Keywords

      Abbreviations:

      aPTT (activated partial thromboplastin time), MAADP (adenosine diphosphate-induced platelet-fibrin clot strength), ADP% (adenosine diphosphate inhibition rate), ADP (adenosine diphosphate), AA (arachidonic acid), MAAA (arachidonic acid-induced platelet-fibrin clot strength), AA% (arachidonic acid inhibition rate), AUC (area under the receiver operating characteristic curve), CAS (carotid artery stenting), CEA (carotid endarterectomy), CI (confidence interval), DWI (diffusion-weighted imaging), IQR (interquartile range), LTA (light transmission aggregometry), MRI (magnetic resonance imaging), MAHKH (maximal amplitude), OR (odds ratio), RROC (Raymond-Roy occlusion classification), ROC (receiver operating characteristic), TEG (thromboelastography), TIA (transient ischemic attack), UIA (unruptured intracranial aneurysm), VER (volume embolization ratio), 3D-DSA (3-dimensional digital subtraction angiography)
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