{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,28]],"date-time":"2026-08-28T16:45:16Z","timestamp":1787935516455,"version":"build-2784847793"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","license":[{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["SVIN"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>The effectiveness of platelet reactivity unit (PRU)\u2013guided individualized antiplatelet therapy for intracranial aneurysm treatment remains uncertain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>This retrospective study evaluated 1705 patients with 1883 unruptured intracranial aneurysms who received endovascular treatments at a tertiary center between March 2018 and December 2020. Patients were divided into 2 groups: a standard group (aspirin and clopidogrel without PRU) and an individualized group where antiplatelet therapy was adjusted or switched to low-dose prasugrel based on preprocedural PRU values by VerifyNow. In the individualized group, hyporesponsiveness was defined as PRU&gt;238 or inhibition &lt;26%, prompting transition to low-dose prasugrel, whereas hyperresponsiveness was defined as PRU&lt;86 or inhibition &gt;74%, leading to dose withholding. The primary outcome was thromboembolic and hemorrhagic complications within 1 month. Thromboembolic complications included intraprocedural thrombosis, transient ischemic attack, and ischemic stroke confirmed on diffusion-weighted imaging; microembolism was defined as acute diffusion-weighted imaging lesions &lt;1\u2009cm. Hemorrhagic complications encompassed intracranial bleeding and extracranial access site hematomas (retroperitoneal hematoma, puncture-site pseudoaneurysm). Functional outcomes were assessed using the modified Rankin Scale. Subgroup analyses were performed for complex procedures, defined as stent-assisted coiling and flow diversion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>\n                      Average patient age was 58.0\u00b110.8 years; 72.4% were female. The cohort included 1020 patients in the standard group and 685 in the individualized group. No significant difference in overall thromboembolic complications was observed between the standard (2.4%) and individualized groups (1.3%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.127). However, individualized therapy significantly reduced thromboembolic events in complex procedures, including stent-assisted embolization and flow diversion (3.3% versus 1.0%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.017;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      for interaction=0.049). In the flow diverter subgroup, the incidence of microembolism was significantly lower in the individualized group (47.8% versus 26.8%;\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.049). Hemorrhagic complication rates were similar between groups.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>Individualized antiplatelet therapy based on PRU measurements did not impact overall outcomes but reduced ischemic complications in complex endovascular treatments without increasing bleeding risks. Further validation is necessary.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/svin.124.001691","type":"journal-article","created":{"date-parts":[[2026,1,21]],"date-time":"2026-01-21T10:00:12Z","timestamp":1768989612000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["Adjusting Antiplatelet Therapy Using P2Y\n                    <sub>12<\/sub>\n                    Reaction Units in Endovascular Treatment of Unruptured Intracranial Aneurysms"],"prefix":"10.1161","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7687-3401","authenticated-orcid":true,"given":"Eunji","family":"Moon","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul (E.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4738-0533","authenticated-orcid":true,"given":"Yunsun","family":"Song","sequence":"additional","affiliation":[{"name":"Department of Radiology (Y.S., B.K., D.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6677-455X","authenticated-orcid":true,"given":"Jung Cheol","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (J.C.P., W.P., J.S.A.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6113-9730","authenticated-orcid":true,"given":"Boseong","family":"Kwon","sequence":"additional","affiliation":[{"name":"Department of Radiology (Y.S., B.K., D.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9977-0595","authenticated-orcid":true,"given":"Wonhyoung","family":"Park","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (J.C.P., W.P., J.S.A.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jae Sung","family":"Ahn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery (J.C.P., W.P., J.S.A.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0355-0449","authenticated-orcid":true,"given":"Deok Hee","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Radiology (Y.S., B.K., D.H.L.), Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dae Chul","family":"Suh","sequence":"additional","affiliation":[{"name":"Department of Neurointervention, GangNam St. Peter\u2019s Hospital, Seoul, Korea 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