Retrospective evaluation of clopidogrel and prasugrel clinical and radiological results in endovascular treatment of intracranial aneurysms made with stent

Intracranial aneurysms are the most common cause of nontraumatic subarachnoid hemorrhage. Coil or stent technique is used in endovascular treatment, and thromboembolic complications are most common during and after treatment. To reduce thromboembolic complications, a dual antiplatelet agent consisting of acetylsalicylic acid (ASA) and clopidogrel is used. Thromboembolic complication rate is thought to be higher in patients with clopidogrel resistance. The aim of our study was to compare three different patient groups in which clopidogrel was used with or without resistance measurement as well as prasugrel was used after resistance measurement. A total of 115 patients with intracranial aneurysms who were treated with flow diverter stent or stent-assisted coil technique were included in our study. Data of patient, lesion and endovascular technique, complications during the follow-up period were determined. Aspirin resistance was found in 7.1% and clopidogrel resistance was present in 54.3% of the patients with resistance measurements. No hemorrhagic complication was observed in patients with aspirin and clopidogrel resistance, and no significant relationship was found between thromboembolic complication and drug resistance. There was no difference in the complication rates during the follow-up period in the groups with and without resistance measurements, whereas the thromboembolic complication rate was significantly higher in the group without resistance measurements. Keywords: Intracranial aneurysm, endovascular treatment, clopidogrel resistance, thromboembolic complication, prasugrel