Predictors of thrombotic complications and mass effect exacerbation after pipeline embolization: The significance of adenosine diphosphate inhibition, fluoroscopy time, and aneurysm size
| Autor: | Gary Duckwiler, Nestor R Gonzalez, Fernando Vinuela, Radoslav Raychev, Reza Jahan, J W Sayre, Viktor Szeder, Satoshi Tateshima |
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| Rok vydání: | 2015 |
| Předmět: |
Male
medicine.medical_specialty Time Factors Exacerbation medicine.medical_treatment Operative Time Prosthesis Design Severity of Illness Index 030218 nuclear medicine & medical imaging 03 medical and health sciences chemistry.chemical_compound 0302 clinical medicine Aneurysm medicine Humans Fluoroscopy Embolization Intraparenchymal hemorrhage Retrospective Studies medicine.diagnostic_test business.industry Mass effect Middle Aged Prognosis medicine.disease Embolization Therapeutic Adenosine Diphosphate Equipment Failure Analysis Survival Rate Adenosine diphosphate Treatment Outcome chemistry Female Radiology Intracranial Thrombosis business Biomarkers 030217 neurology & neurosurgery Thrombotic complication |
| Zdroj: | Interventional Neuroradiology. 22:34-41 |
| ISSN: | 2385-2011 1591-0199 |
| Popis: | Background The mechanisms leading to delayed rupture, distal emboli and intraparenchymal hemorrhage in relation to pipeline embolization device (PED) placement remain debatable and poorly understood. The aim of this study was to identify clinical and procedural predictors of these perioperative complications. Methods We conducted a retrospective review of consecutive patients who underwent PED placement. We utilized a non-commercial platelet aggregation method measuring adenosine diphosphate (ADP)% inhibition for evaluation of clopidogrel response. To our knowledge, this is the first study to test ADP in neurovascular procedures. Multivariable regression analysis was used to identify the strongest predictor of three separate outcomes: (1) thrombotic complications, (2) hemorrhagic complications, and (3) aneurysm mass effect exacerbation Results Permanent complication-related morbidity and mortality at 3 months was 6% (3/48). No specific predictors of hemorrhagic complications were identified. In the univariate analysis, the strongest predictors of thrombotic complications were: ADP % inhibition Conclusions Procedural complexity, reflected by fluoroscopy time, is the strongest predictor of thrombotic complications in this study. ADP% inhibition is a reliable method of testing clopidogrel response in neurovascular procedures and values of |
| Databáze: | OpenAIRE |
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