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Guided Antiplatelet Therapy for Stent-Treated Intracranial Aneurysms: A Cluster-Randomized Trial

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机构： [1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China. [2]Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China. [3]Department of Neurology, The Chinese PLA General Hospital, Beijing, China. [4]China National Clinical Research Center for Neurologic Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. [5]Laboratory Diagnosis Center, Beijing Tiantan Hospital, Capital Medical University, Beijing, China. [6]Department of Neurosurgery, Peking University International Hospital, Beijing, China. [7]Department of Neurosurgery, Peking Union Medical College Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China. [8]Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China. [9]Department of Neurosurgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China. [10]Department of Neurosurgery, Peking University First Hospital, Beijing, China. [11]Department of Neurosurgery, Tianjin Medical University General Hospital, Tianjin, China. [12]Department of Neurosurgery, Beijing Xuanwu Hospital, Capital Medical University, Beijing, China. [13]Department of Clinical Epidemiology and Clinical Trial, Capital Medical University, Beijing, China. [14]Departments of Neurosurgery, Duke University Hospital, Durham, NC. [15]Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western Hospital, University Health Network, Toronto, Canada.

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Background During neurointerventional treatment of intracranial aneurysms (IAs), poor antiplatelet drug response increases the risk of a cerebral ischemic event (IE). Replacing clopidogrel with ticagrelor may reduce this risk. Purpose To determine whether platelet function test (PFT)-guided antiplatelet therapy reduces incidence of IEs compared with standard dual antiplatelet therapy (SDAT; daily oral aspirin and clopidogrel, 100 mg and 75 mg, respectively) in patients undergoing endovascular intervention for IAs. Materials and Methods In this prospective, multicenter, cluster-randomized trial, 16 neurointerventional teams were randomly allocated to eight test and eight control clusters. Between May and August 2023, test group participants underwent PFT. Test group participants who showed poor antiplatelet response were administered an increased aspirin dose or were switched from clopidogrel to ticagrelor. The control group was administered SDAT. The primary outcome was any cerebral IE within 30 days after the procedure. The exploratory outcomes were any IE within 7 days, modified Rankin Scale score, and all-cause mortality within 30 days. The safety outcome measure was any bleeding event within 30 days. All outcome analyses were performed using generalized linear mixed-effects models. Results A total of 590 participants were included (median age, 58 years; 374 women). IE incidence within 30 days was lower in the test group than in the control group (6.8% [20 of 295] vs 13.2% [39 of 295]; odds ratio [OR], 0.54; 95% CI: 0.31, 0.94; P = .03) and within 7 days (4.1% [12 of 295] vs 10.8% [32 of 295]; OR, 0.48; 95% CI: 0.25, 0.89; P = .02) after undergoing the procedure. There was no evidence of a difference between the test group and the control group in modified Rankin Scale scores (0.33 vs 0.49, respectively; P = .11) or mortality (0.3% [one of 295] vs 2.0% [six of 295], respectively; P = .54). Furthermore, there was no evidence of a between-group difference in bleeding event incidence (24.1% [71 of 295] vs 31.2% [92 of 295]; OR, 0.67; 95% CI: 0.30, 1.5; P = .32). Conclusion PFT-guided antiplatelet therapy was associated with reduced IE incidence. Administration of 60 mg of ticagrelor did not increase bleeding event incidence. Clinicaltrials.gov Identifier: NCT05825391 © RSNA, 2025 Supplemental material is available for this article. See also the editorial by Kallmes and Altschul in this issue.

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大类 | 1 区

医学

小类 | 1 区核医学

最新[2025]版：

大类 | 1 区

医学

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出版当年[2023]版：

Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

最新[2024]版：

Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

影响因子： 15.2 最新[2024版] 14.3 最新五年平均 12.1 出版当年[2023版] 13.4 出版当年五年平均 19.7 出版前一年[2022版] 15.2 出版后一年[2024版]

第一作者：

第一作者机构： [1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China. [2]Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.

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通讯作者：

通讯机构： [1]Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, No. 119 South Fourth Ring West Road, Fengtai District, Beijing 100070, China. [2]Department of Interventional Neuroradiology, Beijing Neurosurgical Institute, Capital Medical University, Beijing, China.

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