• Justin E Vranic, Adam A Dmytriw, Inka K Berglar, Naif M Alotaibi, Nicole M Cancelliere, Christopher J Stapleton, James D Rabinov, Pablo Harker, Rajiv Gupta, Joshua D Bernstock, Matthew J Koch, Scott B Raymond, Justin R Mascitelli, T Tyler Patterson, Joshua Seinfeld, Andrew White, David Case, Christopher Roark, Chirag D Gandhi, Fawaz Al-Mufti, Jared Cooper, Charles Matouk, Nanthiya Sujijantarat, Diego A Devia, Maria I Ocampo-Navia, Daniel E Villamizar-Torres, Juan C Puentes, Mohamed M Salem, Ammad Baig, El NamaaniKareemKDepartment of Neurosurgery, Thomas Jefferson University, Philadelphia , Pennsylvania , USA., Anna Luisa Kühn, Bryan Pukenas, Brian T Jankowitz, Jan Karl Burkhardt, Adnan Siddiqui, Pascal Jabbour, Jasmeet Singh, Ajit S Puri, Robert W Regenhardt, Mendes PereiraVitorVNeurovascular Centre, Departments of Medical Imaging & Neurosurgery, St. Michael's Hospital, University of Toronto, Toronto , Ontario , USA., and Aman B Patel.
• Neuroendovascular Program, Departments of Radiology, Neurosurgery and Neurology, Massachusetts General Hospital, Harvard Medical School, BostonMassachusetts , USA.
• Neurosurgery. 2024 Apr 18.

Background And ObjectivesDual antiplatelet therapy (DAPT) is necessary to minimize the risk of periprocedural thromboembolic complications associated with aneurysm embolization using pipeline embolization device (PED). We aimed to assess the impact of platelet function testing (PFT) on reducing periprocedural thromboembolic complications associated with PED flow diversion in patients receiving aspirin and clopidogrel.MethodsPatients with unruptured intracranial aneurysms requiring PED flow diversion were identified from 13 centers for retrospective evaluation. Clinical variables including the results of PFT before treatment, periprocedural DAPT regimen, and intracranial complications occurring within 72 h of embolization were identified. Complication rates were compared between PFT and non-PFT groups. Differences between groups were tested for statistical significance using the Wilcoxon rank sum, Fisher exact, or χ 2 tests. A P -value <.05 was statistically significant.Results580 patients underwent PED embolization with 262 patients dichotomized to the PFT group and 318 patients to the non-PFT group. 13.7% of PFT group patients were clopidogrel nonresponders requiring changes in their pre-embolization DAPT regimen. Five percentage of PFT group [2.8%, 8.5%] patients experienced thromboembolic complications vs 1.6% of patients in the non-PFT group [0.6%, 3.8%] ( P = .019). Two (15.4%) PFT group patients with thromboembolic complications experienced permanent neurological disability vs 4 (80%) non-PFT group patients. 3.7% of PFT group patients [1.5%, 8.2%] and 3.5% [1.8%, 6.3%] of non-PFT group patients experienced hemorrhagic intracranial complications ( P > .9).ConclusionPreprocedural PFT before PED treatment of intracranial aneurysms in patients premedicated with an aspirin and clopidogrel DAPT regimen may not be necessary to significantly reduce the risk of procedure-related intracranial complications.Copyright © Congress of Neurological Surgeons 2024. All rights reserved.

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