Abstract 168: Platelet function testing and risk of periprocedural complications with flow diversion: An international multicenter study

Introduction Dual antiplatelet therapy (DAPT) is necessary to minimize the risk of periprocedural thromboembolic complications associated with aneurysm embolization using Pipeline embolization device (PED). We sought 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. Methods Patients with unruptured intracranial aneurysms requiring PED flow diversion were identified from 13 centers for retrospective evaluation. Clinical variables including the results of PFT prior to treatment, periprocedural DAPT regimen, and intracranial complications occurring within 72‐hours of embolization were identified from the medical record. 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 Chi‐square tests. A p‐value <0.05 was statistically significant. Results 580 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 non‐responders requiring changes in their pre‐embolization DAPT regimen. 5% of PFT group patients experienced thromboembolic complications versus 1.6% of patients in the non‐PFT group (p=0.019). Two (15.4%) PFT group patients with thromboembolic complications experienced permanent neurological disability versus 4 (80%) non‐PFT group patients. 2.2% of PFT group patients and 3.5% of non‐PFT group patients experienced hemorrhagic intracranial complications (p>0.9). Conclusion Pre‐procedural PFT prior to PED treatment of intracranial aneurysms in patients pre‐medicated with an aspirin and clopidogrel DAPT regimen may not be necessary to significantly reduce the risk of procedure‐related intracranial complications.