1080. Elevation of Post-Procedure P2Y12 Reaction Units Levels With Pipeline Embolization of Intracranial Aneurysms

Authors: Joseph R. Linzey, BS; David Wilkinson; Luis Savastano; Joseph Gemmete; Neeraj Chaudhary; Byron Thompson; Aditya Pandey; Julius Griauzde (Ann Arbor, MI)

Introduction: Flow diversion with pipeline embolization devices is an increasingly common method of treating intracranial aneurysms. Due to the risk of thromboembolic complications following the placement of pipeline embolization devices, patients are required to initiate dual antiplatelet therapy. However, there remains controversy regarding the use of platelet function tests before embolization procedures. Methods: A retrospective review of a prospectively maintained database of patients who underwent pipeline embolization for the treatment of intracranial aneurysms was performed. Our primary endpoint was the elevation of the Plavix assay immediately post procedure compared to pre-procedure and whether the post-procedure assay demonstrated therapeutic levels. Descriptive statistics coupled with univariate and multivariate logistic regressions were utilized. Results: Of the 18 patients included in this study, 14 (77.8%) were female with an average age of 50.9 + 15.5. The majority of the aneurysms were anterior circulation (17/18, 94.4%) with an average size of 12.1 + 8.0 mm. The mean number of pipeline stents used to treat each aneurysm were 2.1 + 2.4 and the average procedure length was 171.6 + 73.0 minutes. Among our patients, the average pre-procedure P2Y12 Reaction Units (PRU) was 124.4 + 28.7 which was significantly lower than the average post-procedure PRU of 188.2 + 40.5 (p=0.00012). Of the 18 patients, 11 (61.1%) had a post-procedure PRU that was outside of the therapeutic range and 10 (55.6%) had to be re-dosed in order to restore therapeutic levels. With univariate analysis, the only variable that was associated with a patient having a supratherapeutic PRU was a higher pre-procedure PRU (OR 1.05, 95%CI 1.00-1.10, p=0.05). However, multivariate analysis demonstrated that no variables were associated with non-therapeutic levels. Conclusion: As pipeline embolization becomes an increasingly common method to treat intracranial aneurysms, it is important to monitor peri-operative PRU levels to ensure therapeutic levels.