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

Abstract

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.

Keywords: Blood Platelets; Intracranial Aneurysm; Stents; Stroke; Thrombolysis.

Conflict of interest statement

Competing interests: None declared.

© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.

Figures

Figure 1

ADP-MPA values in different CYP2C19 gene metabolisers. ADP-MPA, maximum platelet aggregation rate induced by ADP; FMs, fast metabolisers; IMs, intermediate metabolisers; PMs, poor metabolisers; UMs, ultra-fast metabolisers.

Figure 2

Receiver operating characteristic curve analysis of ischaemic events in all cases. ADP-MPA, maximum platelet aggregation rate induced by ADP; AUC, area under the curve.

Figure 3

Receiver operating characteristic curve analysis of ischaemic events in different CYP2C19 metabolisers. ADP-MPA, maximum platelet aggregation rate induced by ADP; AUC, area under the curve; FMs, fast metabolisers; IMs, intermediate metabolisers; PMs, poor metabolisers.

Figure 4

Receiver operating characteristic curve analysis of ischaemic events in patients with flow diverters and patients with traditional stents. Red line, flow diverter group; blue line, traditional stent group. ADP-MPA, maximum platelet aggregation rate induced by ADP; AUC, area under the curve.