Safety and Efficacy of Prasugrel with Endovascular Treatment for Unruptured Cerebral Aneurysm

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  • Arimura Koichi
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Imamura Hirotoshi
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Sakai Chiaki
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Tani Shoichi
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Adachi Hidemitsu
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Funatsu Takayuki
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Beppu Mikiya
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Takebe Noriyoshi
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Suzuki Keita
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Okuda Tomohiro
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Matsui Yuichi
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Yoshida Yasunori
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Kawabata Syuhei
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan
  • Sakai Nobuyuki
    Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Hyogo, Japan

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<p>Objective: Recently, dual-antiplatelet therapy (DAPT) including clopidogrel (CLP) with endovascular treatment for unruptured cerebral aneurysm has been widely accepted. However, patients who are poor metabolizers of CLP (CLP-PMs) are more frequent in East Asians than in Caucasians, and an adequate antiplatelet effect may not be achieved with a normal dose in such patients. Prasugrel, which is a novel thienopyridine antiplatelet drug that is less likely to be poorly metabolized than CLP, is used widely for percutaneous coronary intervention, but its efficacy and safety with neuroendovascular treatment have not been elucidated. From this point of view, the purpose of this study was to elucidate the safety and efficacy of prasugrel with endovascular treatment for unruptured cerebral aneurysm.</p><p>Methods: We investigated 108 consecutive patients with an unruptured cerebral aneurysm who underwent endovascular treatment from March 2015 to January 2016 in our hospital. All patients received DAPT with 100 mg aspirin and 75 mg CLP daily, and antiplatelet function was evaluated by VerifyNow (Accumetrics, San Diego, CA, USA). In patients with P2Y12 reaction units (PRU) over 230, prasugrel was administered with a loading dose of 20 mg and a maintenance dose of 3.75 mg daily.</p><p>Results: Prasugrel was administered to 12 patients in our series. Of these patients, the mean age was 63.1 ± 13.0 years, and the mean PRU was 272 ± 20. Eleven patients received endovascular treatment with intracranial stents, of which four patients received treatment with flow diverters. The mean observational period was 5–13 months (median: 6.5), and no symptomatic hemorrhagic and ischemic complications occurred. Mean PRU was decreased to 159 ± 63 in the six patients in which PRU were re-examined.</p><p>Conclusion: Prasugrel is safe and effective with endovascular treatment for unruptured cerebral aneurysm in CLP-PMs.</p>

収録刊行物

  • 脳神経血管内治療

    脳神経血管内治療 11 (11), 553-557, 2017

    特定非営利活動法人 日本脳神経血管内治療学会

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