Review ARTICLE

Front. Neurol., 26 December 2011 | http://dx.doi.org/10.3389/fneur.2011.00083

Antiplatelet resistance and thromboembolic complications in neurointerventional procedures

Thomas J. Oxley1*, Richard J. Dowling2, Peter J. Mitchell2, Stephen Davis1 and Bernard Yan1,2*
  • 1 Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
  • 2 Department of Radiology, The Royal Melbourne Hospital, Melbourne, VIC, Australia

Antiplatelet resistance is emerging as a significant factor in effective secondary stroke prevention. Prevalence of aspirin and clopidogrel resistance is dependent upon laboratory test and remains contentious. Large studies in cardiovascular disease populations have demonstrated worse ischemic outcomes in patients with antiplatelet resistance, particularly in patients with coronary stents. Thromboembolism is a complication of neurointerventional procedures that leads to stroke. Stroke rates related to aneurysm coiling range from 2 to 10% and may be higher when considering silent ischemia. Stroke associated with carotid stenting is a major cause of morbidity. Antiplatelet use in the periprocedure setting varies among different centers. No guidelines exist for use of antiplatelet regimens in neurointerventional procedures. Incidence of stroke in patients post procedure may be partly explained by resistance to antiplatelet agents. Further research is required to establish the incidence of stroke in patients with antiplatelet resistance undergoing neurointerventional procedures.

Keywords: antiplatelet resistance, thromboembolism, endovascular, neurointervention, aspirin, clopidogrel

Citation: Oxley TJ, Dowling RJ, Mitchell PJ, Davis S and Yan B (2011) Antiplatelet resistance and thromboembolic complications in neurointerventional procedures. Front. Neur. 2:83. doi: 10.3389/fneur.2011.00083

Received: 25 July 2011; Paper pending published: 14 September 2011;
Accepted: 30 November 2011; Published online: 26 December 2011.

Edited by:

Alex Abou-Chebl, University of Louisville School of Medicine, USA

Reviewed by:

Alex Abou-Chebl, University of Louisville School of Medicine, USA
Johanna Fifi, Albert Einstein College of Medicine, USA
Marc Lazzaro, Medical College of Wisconsin, USA

Copyright: © 2011 Oxley, Dowling, Mitchell, Davis and Yan. This is an open-access article distributed under the terms of the Creative Commons Attribution Non Commercial License, which permits non-commercial use, distribution, and reproduction in other forums, provided the original authors and source are credited.

*Correspondence: Thomas J. Oxley, Department of Neurology, The Royal Melbourne Hospital, Grattan Street Parkville, Melbourne, VIC 3050, Australia. e-mail: tom.oxley@mh.org.au; Bernard Yan, The Royal Melbourne Hospital, Melbourne, VIC 3050, Australia e-mail: bernard.yan@mh.org.au