Roles of light transmission aggregometry and CYP2C19 genotype in predicting ischaemic complications during interventional therapy for intracranial aneurysms  

作　　者：Yangyang Zhou Wenqiang Li Chao Wang Ruhang Xie Yongnan Zhu Qichen Peng Limin Zhang Hongqi Zhang Yuxiang Gu Shiqing Mu Jian Liu Xinjian Yang 

机构地区：[1]Department of Interventional Neuroradiology,Beijing Neurosurgical Institute and Beijing Tiantan Hospital,Capital Medical University,Beijing,China [2]Department of Neurosurgery,The First Affiliated Hospital of Zhengzhou University,Zhengzhou,Henan,China [3]Department of Clinical Diagnosis Laboratory,Beijing Tiantan Hospital,Capital Medical University,Beijing,China [4]Department of Neurosurgery,Xuanwu Hospital,Capital Medical University,Beijing,China [5]Department of Neurosurgery,Huashan Hospital,Fudan University,Shanghai,China

出　　处：《Stroke & Vascular Neurology》2023年第4期327-334,共8页卒中与血管神经病学（英文）

基　　金：funded by the National Natural Science Foundation of China(81671139 and 82072036);Capital's Funds for Health Improvement and Research(2022-1-2041)and Summit Talent Program(DFL20220503).

摘　　要：Background and purpose Light transmission aggregometry(LTA)and CYP2C19 genotype analysis are commonly used to evaluate the antiplatelet effects of clopidogrel during the interventional treatment of intracranial aneurysms.The aim of this study was to determine which test can predict ischaemic events during these treatments.Methods Patient demographic information,imaging data,laboratory data and ischaemic complications were recorded.LTA and CYP2C19 genotype results were compared,and multiple linear regression was performed to examine factors related to platelet reactivity.Multivariate regression analysis was performed to determine whether LTA and CYP2C19 could predict ischaemic complications and to identify other clinical risk factors.Receiver operating characteristic curve analysis was conducted to calculate the cut-off value for predicting ischaemic complications.A subgroup analysis was also performed for different CYP2C19 genotype metabolisers,as well as for patients with flow diverters and traditional stents.Results A total of 379 patients were included,of which 22 developed ischaemic events.Maximum platelet aggregation induced by ADP(ADP-MPA)could predict ischaemic events(p<0.001;area under the curve,0.752(95%CI 0.663 to 0.842)),and its cut-off value was 41.5%.ADP-MPA(p=0.001)and hypertension duration>10 years(p=0.022)were independent risk factors for ischaemic events,while the CYP2C19 genotype was not associated with ischaemic events.In the subgroup analysis,ADP-MPA could predict ischaemic events in fast metabolisers(p=0.004)and intermediate metabolisers(p=0.003).The cut-off value for ischaemic events was lower in patients with flow diverters(ADP-MPA=36.4%)than in patients with traditional stents(ADP-MPA=42.9%).Conclusions ADP-MPA can predict ischaemic complications during endovascular treatment of intracranial aneurysms.Patients with flow diverters require stronger antiplatelet medication than patients with traditional stents.

关 键 词：CYP2C19 ISCHAEMIC INTRACRANIAL 

分 类 号：R743.3[医药卫生—神经病学与精神病学]