TY - JOUR
T1 - Clopidogrel response predicts thromboembolic events associated with coil embolization of unruptured intracranial aneurysms
T2 - A prospective cohort study
AU - Higashi, Eiji
AU - Matsumoto, Shoji
AU - Nakahara, Ichiro
AU - Hatano, Taketo
AU - Ishii, Akira
AU - Sadamasa, Nobutake
AU - Ohta, Tsuyoshi
AU - Ishihara, Takuma
AU - Tokunaga, Keisuke
AU - Ando, Mitsushige
AU - Chihara, Hideo
AU - Furuta, Konosuke
AU - Hashimoto, Tetsuya
AU - Tanaka, Koji
AU - Sonoda, Kazutaka
AU - Koge, Junpei
AU - Takita, Wataru
AU - Hashikawa, Takuro
AU - Funakoshi, Yusuke
AU - Kondo, Daisuke
AU - Kamata, Takahiko
AU - Tsujimoto, Atsushi
AU - Matsushita, Takuya
AU - Murai, Hiroyuki
AU - Matsuo, Keitaro
AU - Kitazono, Takanari
AU - Kira, Junichi
N1 - Publisher Copyright:
© 2021 Higashi et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2021/4
Y1 - 2021/4
N2 - Objective Periprocedural thromboembolic events are a serious complication associated with coil embolization of unruptured intracranial aneurysms. However, no established clinical rule for predicting thromboembolic events exists. This study aimed to clarify the significance of adding preoperative clopidogrel response value to clinical factors when predicting the occurrence of thromboembolic events during/after coil embolization and to develop a nomogram for thromboembolic event prediction. Methods In this prospective, single-center, cohort study, we included 345 patients undergoing elective coil embolization for unruptured intracranial aneurysm. Thromboembolic event was defined as the occurrence of intra-procedural thrombus formation and postprocedural symptomatic cerebral infarction within 7 days. We evaluated preoperative clopidogrel response and patients' clinical information. We developed a patient-clinical-information model for thromboembolic event using multivariate analysis and compared its efficiency with that of patient-clinical-information plus preoperative clopidogrel response model. The predictive performances of the two models were assessed using area under the receiver-operating characteristic curve (AUC-ROC) with bootstrap method and compared using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results Twenty-eight patients experienced thromboembolic events. The clinical model included age, aneurysm location, aneurysm dome and neck size, and treatment technique. AUCROC for the clinical model improved from 0.707 to 0.779 after adding the clopidogrel response value. Significant intergroup differences were noted in NRI (0.617, 95% CI: 0.247-0.987, p < .001) and IDI (0.068, 95% CI: 0.021-0.116, p = .005). Conclusions Evaluation of preoperative clopidogrel response in addition to clinical variables improves the prediction accuracy of thromboembolic event occurrence during/after coil embolization of unruptured intracranial aneurysm.
AB - Objective Periprocedural thromboembolic events are a serious complication associated with coil embolization of unruptured intracranial aneurysms. However, no established clinical rule for predicting thromboembolic events exists. This study aimed to clarify the significance of adding preoperative clopidogrel response value to clinical factors when predicting the occurrence of thromboembolic events during/after coil embolization and to develop a nomogram for thromboembolic event prediction. Methods In this prospective, single-center, cohort study, we included 345 patients undergoing elective coil embolization for unruptured intracranial aneurysm. Thromboembolic event was defined as the occurrence of intra-procedural thrombus formation and postprocedural symptomatic cerebral infarction within 7 days. We evaluated preoperative clopidogrel response and patients' clinical information. We developed a patient-clinical-information model for thromboembolic event using multivariate analysis and compared its efficiency with that of patient-clinical-information plus preoperative clopidogrel response model. The predictive performances of the two models were assessed using area under the receiver-operating characteristic curve (AUC-ROC) with bootstrap method and compared using net reclassification improvement (NRI) and integrated discrimination improvement (IDI). Results Twenty-eight patients experienced thromboembolic events. The clinical model included age, aneurysm location, aneurysm dome and neck size, and treatment technique. AUCROC for the clinical model improved from 0.707 to 0.779 after adding the clopidogrel response value. Significant intergroup differences were noted in NRI (0.617, 95% CI: 0.247-0.987, p < .001) and IDI (0.068, 95% CI: 0.021-0.116, p = .005). Conclusions Evaluation of preoperative clopidogrel response in addition to clinical variables improves the prediction accuracy of thromboembolic event occurrence during/after coil embolization of unruptured intracranial aneurysm.
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U2 - 10.1371/journal.pone.0249766
DO - 10.1371/journal.pone.0249766
M3 - Article
C2 - 33831086
AN - SCOPUS:85104126007
SN - 1932-6203
VL - 16
JO - PloS one
JF - PloS one
IS - 4 April
M1 - e0249766
ER -