Clopidogrel response predicts thromboembolic events associated with coil embolization of unruptured intracranial aneurysms: A prospective cohort study

被引：3

作者：

Higashi, Eiji ^{[1
]}

Matsumoto, Shoji ^{[2
,21
]}

Nakahara, Ichiro ^{[1
,21
]}

Hatano, Taketo ^{[1
]}

Ishii, Akira ^{[3
]}

Sadamasa, Nobutake ^{[4
]}

Ohta, Tsuyoshi ^{[5
]}

Ishihara, Takuma ^{[6
]}

Tokunaga, Keisuke ^{[7
]}

Ando, Mitsushige ^{[8
]}

Chihara, Hideo ^{[1
]}

Furuta, Konosuke ^{[2
]}

Hashimoto, Tetsuya ^{[9
]}

Tanaka, Koji ^{[10
]}

Sonoda, Kazutaka ^{[11
]}

Koge, Junpei ^{[12
]}

Takita, Wataru ^{[13
]}

Hashikawa, Takuro ^{[14
]}

Funakoshi, Yusuke ^{[15
]}

Kondo, Daisuke ^{[2
]}

Kamata, Takahiko ^{[1
]}

Tsujimoto, Atsushi ^{[16
]}

Matsushita, Takuya ^{[10
]}

Murai, Hiroyuki ^{[17
]}

Matsuo, Keitaro ^{[18
,19
]}

Kitazono, Takanari ^{[20
]}

Kira, Junichi ^{[10
]}

机构：

[1] Kokura Mem Hosp, Stroke Ctr, Dept Neurosurg, Kitakyushu, Fukuoka, Japan

[2] Kokura Mem Hosp, Stroke Ctr, Dept Neurol, Kitakyushu, Fukuoka, Japan

[3] Kyoto Univ, Dept Neurosurg, Grad Sch Med, Kyoto, Japan

[4] Koseikai Takeda Hosp, Stroke Ctr, Dept Neurosurg, Kyoto, Japan

[5] Natl Cerebral & Cardiovasc Ctr, Dept Neurosurg, Osaka, Japan

[6] Gifu Univ Hosp, Innovat & Clin Res Promot Ctr, Gifu, Japan

[7] Natl Hosp Org Kyushu Med Ctr, Dept Cerebrovasc Med & Neurol, Fukuoka, Japan

[8] Shiga Gen Hosp, Dept Neurosurg, Moriyama, Japan

[9] Univ Calif Los Angeles, Dept Neurol, Los Angeles, CA 90024 USA

[10] Kyushu Univ, Grad Sch Med Sci, Dept Neurol, Fukuoka, Japan

[11] Fukuoka Saiseikai Gen Hosp, Dept Neurol, Fukuoka, Japan

[12] Natl Cerebral & Cardiovasc Ctr, Dept Cerebrovasc Med, Osaka, Japan

[13] Natl Hosp Org Nagoya Med Ctr, Dept Neurol, Nagoya, Aichi, Japan

[14] St Marys Hosp, Dept Neurosurg, Kurume, Fukuoka, Japan

[15] Kyushu Univ, Grad Sch Med Sci, Dept Neurosurg, Fukuoka, Japan

[16] Japan Community Hlth Care Org Kyushu Hosp, Dept Neurol, Kitakyushu, Fukuoka, Japan

[17] Int Univ Hlth & Welf, Dept Neurol, Narita, Japan

[18] Aichi Canc Ctr Res Inst, Div Canc Epidemiol & Prevent, Nagoya, Aichi, Japan

[19] Nagoya Univ, Dept Canc Epidemiol, Grad Sch Med, Nagoya, Aichi, Japan

[20] Kyushu Univ, Grad Sch Med Sci, Dept Med & Clin Sci, Fukuoka, Japan

[21] Fujita Hlth Univ, Dept Comprehens Strokol, Toyoake, Aichi, Japan

来源：

PLOS ONE | 2021年 / 16卷 / 04期

基金：

日本学术振兴会;

关键词：

PERCUTANEOUS CORONARY INTERVENTION; MODIFIED ANTIPLATELET PREPARATION; VERIFYNOW P2Y12 ASSAY; PLATELET REACTIVITY; ENDOVASCULAR TREATMENT; CEREBRAL ANEURYSMS; CLINICAL-OUTCOMES; COMPLICATIONS; VARIABILITY; EXPERIENCE;

D O I：

10.1371/journal.pone.0249766

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Objective Periprocedural thromboembolic events are a serious complication associated with coil embolization of unruptured intracranial aneurysms. However, no established clinical rule for predicting thromboembolic events exists. This study aimed to clarify the significance of adding preoperative clopidogrel response value to clinical factors when predicting the occurrence of thromboembolic events during/after coil embolization and to develop a nomogram for thromboembolic event prediction. Methods In this prospective, single-center, cohort study, we included 345 patients undergoing elective coil embolization for unruptured intracranial aneurysm. Thromboembolic event was defined as the occurrence of intra-procedural thrombus formation and postprocedural symptomatic cerebral infarction within 7 days. We evaluated preoperative clopidogrel response and patients' clinical information. We developed a patient-clinical-information model for thromboembolic event using multivariate analysis and compared its efficiency with that of patient-clinical-information plus preoperative clopidogrel response model. The predictive performances of the two models were assessed using area under the receiver-operating characteristic curve (AUC-ROC) with bootstrap method and compared using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results Twenty-eight patients experienced thromboembolic events. The clinical model included age, aneurysm location, aneurysm dome and neck size, and treatment technique. AUC-ROC for the clinical model improved from 0.707 to 0.779 after adding the clopidogrel response value. Significant intergroup differences were noted in NRI (0.617, 95% CI: 0.247-0.987, p < .001) and IDI (0.068, 95% CI: 0.021-0.116, p = .005). Conclusions Evaluation of preoperative clopidogrel response in addition to clinical variables improves the prediction accuracy of thromboembolic event occurrence during/after coil embolization of unruptured intracranial aneurysm.

引用

页数：13

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