{
  "abstract": "Introduction Under- or over-suppression of platelet aggregation by antiplatelet medication may be a contributing factor to major stroke or neurological death following flow diversion stenting (FDS) for intracranial aneurysms. Our institutional practice is to adjust the doses of antiplatelets based on peri-procedural Multiplate® Analyzer platelet function testing (PFT) to avoid under- or over-suppression of platelet aggregation. We aimed to describe this practice in consecutive patients with internal carotid artery (ICA) aneurysms that were treated electively with FDS.Methods We retrospectively reviewed the medical records of all patients treated with FDS for intracranial aneurysms at our institution between 1 July 2015 and 30 June 2025. Patients with an ICA aneurysm treated electively with FDS and with antiplatelet doses guided by PFT were included. Patients were classified as having either low-, standard-, or high-dose antiplatelets based on their discharge doses. Standard doses were defined as aspirin 100 mg/day plus one of either prasugrel (10 mg/day if ≥60 kg or 5 mg/day if <60 kg), clopidogrel 75 mg/day, or ticagrelor 180 mg/day for 3-6 months. Antiplatelet doses lower or higher than these were classified as low- or high-dose respectively. The primary outcome was major ipsilateral stroke (National Institutes of Health Stroke Scale score ≥4) or neurological death within 6 months.Results 193 patients were treated for intracranial aneurysms with FDS at our institution in the study period, of whom 109 (57.4±12.9 years, 94 [86.2%] female) were treated electively for an ICA aneurysm and were included. 30 (27.5%) aneurysms were currently or previously symptomatic. Mean±SD aneurysm diameter was 9.6±6.2 mm. Adjunctive or previous coiling was performed in 36 (33.0%) patients. Peri-procedural PFT was performed in 109 (100%) patients. Mean±SD ADP, ASP, and TRAP results were 22.5±7.6 AU, 12.8±7.8 AU, and 104.1±26.0 AU respectively. Aspirin (range 25-100 mg/day) was used in 109 (100%), prasugrel (range 1.25-15 mg/day) in 74 (67.9%), clopidogrel (range 37.5-75 mg/day) in 33 (30.3%), and ticagrelor (range 90-180 mg/day) in 2 (1.8%) patients. Low-dose antiplatelets were used in 57 (52.3%), standard-dose in 50 (45.9%), and high-dose in 2 (1.8%) patients. 2 (1.8%) patients met the primary outcome (1 patient suffered neurological death in each of the standard- and low-dose groups), and 2 (1.8%) patients had peri-procedural strokes that did not meet the primary outcome.Conclusions Peri-procedural PFT commonly led neurointerventionalists to prescribe a low-dose antiplatelet regime in patients undergoing elective FDS for ICA aneurysms. The overall rate of major stroke or neurological death was low, indicating that adjusting antiplatelet doses based on PFT results is safe.Disclosures W. Diprose: None. T. Ottavi: None. R. Zinn: None. P. Garcia-Bermejo: None. F. Miteff: None.",
  "authors": [
    {
      "affiliations": [
        "Endovascular Neurointervention Service, Department of Neurology, Hunter New England Local Health District, NSW, Australia"
      ],
      "name": "W Diprose"
    },
    {
      "affiliations": [
        "Endovascular Neurointervention Service, Department of Neurology, Hunter New England Local Health District, NSW, Australia"
      ],
      "name": "T Ottavi"
    },
    {
      "affiliations": [
        "Endovascular Neurointervention Service, Department of Neurology, Hunter New England Local Health District, NSW, Australia"
      ],
      "name": "R Zinn"
    },
    {
      "affiliations": [
        "Endovascular Neurointervention Service, Department of Neurology, Hunter New England Local Health District, NSW, Australia"
      ],
      "name": "P Garcia-Bermejo"
    },
    {
      "affiliations": [
        "Endovascular Neurointervention Service, Department of Neurology, Hunter New England Local Health District, NSW, Australia"
      ],
      "name": "F Miteff"
    }
  ],
  "title": "P-023 Platelet function testing-guided antiplatelet dosing for elective flow diversion of internal carotid artery aneurysms",
  "uid": "235ec6cf-843b-5116-9e67-96ebd722a37b"
}