{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T02:14:46Z","timestamp":1783649686827,"version":"3.55.0"},"reference-count":39,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,11,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Concern about thromboembolic events after flow diversion (FD) warrants dual antiplatelet therapy for 3 to 6 months. Platelet function tests are routinely performed prior to the procedure to detect clopidogrel responsiveness, as resistance is associated with <jats:italic>CYP2C19<\/jats:italic> gene polymorphisms. This study aimed to identify optimal cutoff values in light transmission aggregometry (LTA) for clopidogrel and aspirin as predictive indicators of thromboembolic complications.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>The authors conducted a retrospective analysis of aneurysms treated with FD between 2013 and 2023 at a single academic institution. Patients with LTA data for adenosine diphosphate (ADP) and arachidonic acid (ARA) were included, excluding those with aborted procedures. Receiver operating characteristic curves were plotted for ADP and ARA assays to determine optimal cutoff values.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>A total of 442 patients harboring 552 aneurysms treated in 485 procedures were selected for this analysis. Complete and near-complete aneurysm occlusion on the last radiological follow-up was achieved in 81.8% of aneurysms in a median last imaging follow-up of 13.9 months. A good functional outcome (modified Rankin Scale score \u2264 2) was achieved in 96.3% of patients on the last follow-up. Thromboembolic complications occurred in 4.9% of procedures, and intracranial hemorrhagic complications in 1.9%. For the ADP assay, a value \u2265 40% reached a sensitivity of 82.1% and a specificity of 42.9% with a positive likelihood ratio (LR) of 1.50. For the ARA assay, a value \u2265 13.5% reached a sensitivity of 82.1% and a specificity of 45.6% with a positive LR of 1.51.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>This study analyzed the largest FD-treated cohort in which optimal LTA platelet function thresholds for clopidogrel were evaluated and is the first to assess LTA values for aspirin. The authors found that values \u2265 40% for clopidogrel and \u2265 13.5% for aspirin were optimal for predicting thromboembolic complications after FD in treating aneurysms.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2024.3.jns2487","type":"journal-article","created":{"date-parts":[[2024,6,1]],"date-time":"2024-06-01T02:08:38Z","timestamp":1717207718000},"page":"1168-1176","source":"Crossref","is-referenced-by-count":6,"title":["Defining light transmission aggregometry cutoff values for clopidogrel and aspirin resistance in flow diversion treatment of intracranial aneurysms"],"prefix":"10.3171","volume":"141","author":[{"given":"Alejandro","family":"Enriquez-Marulanda","sequence":"first","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"},{"name":"Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jean","family":"Filo","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Felipe","family":"Ramirez-Velandia","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Fodor","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Sconzo","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Young","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandeep","family":"Muram","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Max","family":"Shutran","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin","family":"Granstein","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Taussky","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher S.","family":"Ogilvy","sequence":"additional","affiliation":[{"name":"Neurosurgical Division, Beth Israel Deaconess Medical Center, Boston;"},{"name":"Harvard Medical School, Boston; and"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"5","key":"b1","series-title":"J Neurosurg","first-page":"1317","article-title":"Flow diversion: a disruptive technology coming of age. 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