LAUSR

INTRODUCTION Dual antiplatelet therapy consisting of aspirin and clopidogrel is standard of care for neurointerventional stenting and flow diversion. Platelet function testing is increasingly performed to identify clopidogrel hypo- or hyper-responders. Ticagrelor is a popular alternative antiplatelet agent for those patients. Here, we assessed the role of platelet function testing in patients on ticagrelor receiving stenting or flow diversion. METHODS Patients undergoing stent-assisted coiling or Pipeline flow diversion of a cerebral aneurysm on ticagrelor at any point during their treatment course from May 2017 to August 2019 at a single academic institution in the United States were retrospectively reviewed. Platelet function testing was used to determine P2Y12 reactive units (PRU) and correlated with procedural complications. RESULTS Twenty-eight patients with 29 aneurysms were treated on ticagrelor. Sixteen aneurysms (55.2%) were treated with flow diversion and 13 (44.8%) with stent-assisted coiling. There were 4 (13.8%) thromboembolic and no hemorrhagic complications. Amongst the 8 patients with at least 1 PRU above 100, 4 (50%) had a thromboembolic complication. The patients who did not have a PRU value above 100 did not have any complications. CONCLUSION There is a risk of thromboembolic complications in patients on ticagrelor, which correlates with PRUs in this preliminary study. Findings of this study suggest that the safe PRU range on ticagrelor may be shifted to between 0 - 100 which is lower than that of clopidogrel, which is thought to be from 60 to 210. Further validation of the optimal PRU range on ticagrelor is necessary.