LTA-guided Antiplatelet Therapy in Interventional Treatment of Intracranial Aneurysms

Standardization of Antiplatelet Therapy in Intracranial Aneurysm Intervention With Stents: a Cluster Randomized Controlled Cohort Study

Xuanwu Hospital, Beijing, Chinese PLA General Hospital, Beijing Chao Yang Hospital, Peking University International Hospital, Peking University First Hospital, Hebei Medical University Third Hospital, Tianjin Medical University General Hospital

The use of intracranial stents broadens the indications for endovascular treatment of intracranial aneurysms and improves the cure rate, but it also increases the risk of postoperative ischemic complications in patients. The current standard dual antiplatelet regimen is considered to be an important method to reduce thrombotic events. However, some patients are resistant to antiplatelet drugs and have a high risk of thrombotic events. In actual clinical work, the standards for platelet function testing are not standardized, and the antiplatelet drug adjustment program also lacks norms and consensus. This study carried out a multi-center, prospective cluster randomized controlled study to explore whether the standardized antiplatelet adjustment program guided by LTA detection can reduce the incidence of ischemic events after stent implantation in patients with intracranial unruptured aneurysms. Further determine and correct the curative effect of the standardized use of antiplatelet drugs in the treatment of intracranial aneurysm stents, and finally formulate a set of standardized antiplatelet regimens.

MPA-AA≥20%, give aspirin 200mg qd; MPA-ADP≥36.4%, give ticagrelor 60mg bid; MPA-ADP≥42.9%, give ticagrelor 60mg bid; MPA-ADP<20%, give Clopidogrel 37.5mg qd; The timing of drug adjustment should be at least 1 day before stent implantation, and the LTA results should be checked again after the drug adjustment, and the second antiplatelet drug adjustment should be performed for patients with drug overdose: *Aspirin overdose: Give 100mg, qd; *Ticagrelor overdose: reduce to 45mg, bid;.

Inclusion Criteria: Patients with unruptured intracranial aneurysms who received intracranial stenting, Standard dual-antibody therapy for at least 5 days before stent implantation, Patients aged 18-80, on the day of registration patients with a Modified Rankin Score lower than 2, patients who agree and sign the consent form. Exclusion Criteria: Patients with recurrent aneurysms after interventional therapy or clipping therapy, Patients with a history of allergy to aspirin, clopidogrel or ticagrelor, Patients who used tilofiban prophylactically before surgery, Possible active bleeding Patients with high blood pressure, such as symptomatic intracranial hemorrhage or active gastric ulcer; or patients with bleeding tendency or coagulation dysfunction, Any abnormal platelet count (normal value is 100-300 × 10^9/L), Patients using Anticoagulants, Pregnant or lactating women, Suffering from liver disease, kidney disease, congestive heart failure, malignant tumors and other malignant diseases.