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)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: December 09, 2022
Accepted:
December 4,
2022
Received in revised form:
November 18,
2022
Received:
August 4,
2022
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2022.106924
Copyright
© 2022 Elsevier Inc. All rights reserved.
