• Hyun Ho Choi, Jung Jun Lee, Young Dae Cho, Moon Hee Han, Won-Sang Cho, Jeong Eun Kim, Sang Joon An, Jong Hyeon Mun, Dong Hyun Yoo, and Hyun-Seung Kang.
• Department of Neurosurgery, Dongk-uk University Hospital, Dongkuk Unive-rsity College of Medicine, Ilsan, Korea.
• Neurosurgery. 2018 Nov 1; 83 (5): 981-988.

BackgroundThe use of antiplatelet medications to prevent thrombosis in the treatment of cerebral aneurysms with stents has become widely emphasized.ObjectiveTo compare low-dose prasugrel with clopidogrel in stent-assisted coil embolization of intracranial aneurysms.MethodsThis is a retrospective review of 311 aneurysms from 297 patients who underwent stent-assisted endovascular coil embolization of unruptured intracranial aneurysm between November 2014 and March 2017. Thromboembolic and hemorrhagic adverse events were compared between 207 patients who received low-dose prasugrel (PSG group) and 90 patients who received clopidogrel (CPG group).ResultsP2Y12 reaction unit (PRU) values were significantly lower in the PSG group (PSG group vs CPG group, 132.3 ± 76.9 vs 238.1 ± 69.1; P < .001); the percentage of inhibition was also statistically higher in the PSG group (54.0 ± 26.0% vs 20.8 ± 18.6%; P < .001). Thromboembolic events occurred less frequently in the PSG group than in the CPG group (0.9% vs 6.4%; P = .01), whereas there was no significant difference in the percentage of hemorrhagic complications (0.5% vs 2.2%; P = .22). In the multivariate analysis, clopidogrel as the antiplatelet medication was the sole significant risk factor for thromboembolism in this series of patients undergoing stent-assisted coil embolization.ConclusionUse of low-dose PSG as an antiplatelet premedication is quick, effective, and safe for stent-assisted coil embolization of unruptured intracranial aneurysms. Prasugrel premedication significantly lowered the frequency of thromboembolic events without increasing the risk of hemorrhage.

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