Antiplatelet Therapy for Prevention of Thromboembolic Complications Associated with Coil Embolization of Unruptured Cerebral Aneurysms

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Abstract

Background:

Antiplatelet agents are used during endovascular treatment of cerebral aneurysms to prevent thromboembolic complications.

Objective:

The aim of this study was to investigate the efficacy of clopidogrel for the prevention of thromboembolic complications during elective coil embolization of unruptured cerebral aneurysms.

Methods:

Sixty-three patients prospectively received oral clopidogrel 75 mg/day from 3 days before and for 1 day after the procedure at our institute (Kohnan Hospital, Sendai, Japan) during 2007.

Results:

At 24 hours post-coiling, significantly less high-intensity areas, detected by MRI with diffusion-weighted imaging (MRI-DWI), were observed in clopidogrel-treated patients compared with a historical control cohort of aspirin (acetylsalicylic acid)-treated patients (13/63 [20.6%] vs 27/69 [39.1%]; p = 0.02), primarily due to a statistically significantly lower rate during repair of small (<10 mm) lesions (p = 0.008). Also, the rate of periprocedural thromboembolic events was lower in the clopidogrel than the aspirin cohort (2/63 [3.2%] vs 5/69 [7.2%]; p = 0.3).

Conclusions:

Clopidogrel was generally well tolerated with no signs of hemorrhagic complications or liver dysfunction.

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