Abstract
A small wide-necked incidental aneurysm of the anterior communicating artery (AcomA) was found in a 65-year-old woman, who was healthy apart from a history of mild arterial hypertension. After discussing all potential management options with the patient and her husband, the final decision was taken to treat the aneurysm by coil occlusion, assisted by a pCONus stent (phenox). The patient was prepared for the stent implantation with dual platelet function inhibition through acetylsalicylic acid (ASA) and clopidogrel. The endovascular procedure was carried out as intended. A pCONus_mini was implanted via the left internal carotid artery and the left A1 segment, with its distal end level with the neck of the AcomA aneurysm, followed by the coil occlusion of the aneurysm. The following morning after this procedure, the patient became aphasic and observed a visual field cut to the right. MRI showed a 5.5 × 3.5 × 3.5 cm intracerebral hematoma in the left temporal and occipital lobe, which was managed conservatively. Multiplate tests (Roche Diagnostics) revealed a hyper-response to the ASA and clopidogrel, which required a monitored dosage reduction of both medications. The phenomenon of hyper-response to medical antiaggregation and the management of this condition are the main topics of this chapter.
Keywords
This is a preview of subscription content, log in via an institution.
References
Clavijo LC, Al-Asady N, Dhillon A, Matthews RV, Caro J, Tun H, Rowe V, Shavelle DM. Prevalence of high on-treatment (aspirin and clopidogrel) platelet reactivity in patients with critical limb ischemia. Cardiovasc Revasc Med. 2017. https://doi.org/10.1016/j.carrev.2017.10.013. pii: S1553-8389(17)30403-7.
Cuisset T, Frere C, Poyet R, Quilici J, Gaborit B, Bali L, Brissy O, Lambert M, Morange PE, Alessi MC, Bonnet JL. Clopidogrel response: head-to-head comparison of different platelet assays to identify clopidogrel non responder patients after coronary stenting. Arch Cardiovasc Dis. 2010a;103(1):39–45. https://doi.org/10.1016/j.acvd.2009.11.004.
Cuisset T, Frere C, Quilici J, Uhry S, Alessi MC, Bonnet JL. Post-PCI fatal bleeding in aspirin and clopidogrel hyper responder: shifting from antiplatelet resistance to bleeding risk assessment? Int J Cardiol. 2010b;138(2):212–3. https://doi.org/10.1016/j.ijcard.2008.06.044.
Delgado Almandoz JE, Kadkhodayan Y, Crandall BM, Scholz JM, Fease JL, Tubman DE. Variability in initial response to standard clopidogrel therapy, delayed conversion to clopidogrel hyper-response, and associated thromboembolic and hemorrhagic complications in patients undergoing endovascular treatment of unruptured cerebral aneurysms. J Neurointerv Surg. 2014;6(10):767–73. https://doi.org/10.1136/neurintsurg-2013-010976.
Flechtenmacher N, Kämmerer F, Dittmer R, Budde U, Michels P, Röther J, Eckert B. Clopidogrel resistance in neurovascular stenting: correlations between light transmission aggregometry, VerifyNow, and the multiplate. AJNR Am J Neuroradiol. 2015;36(10):1953–8. https://doi.org/10.3174/ajnr.A4388.
Ghamasaee P, Carr K, Johnson J, Grandhi R. Malignant stroke in a ticagrelor non-responder as a complication following aneurysm treatment with the Pipeline Embolization Device™. Interv Neuroradiol. 2017;23(3):297–300. https://doi.org/10.1177/1591019917697473.
Goh C, Churilov L, Mitchell P, Dowling R, Yan B. Clopidogrel hyper-response and bleeding risk in neurointerventional procedures. AJNR Am J Neuroradiol. 2013;34(4):721–6. https://doi.org/10.3174/ajnr.A3418.
Müller I, Besta F, Schulz C, Massberg S, Schönig A, Gawaz M. Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement. Thromb Haemost. 2003;89(5):783–7.
Xanthopoulou I, Stavrou EF, Kassimis G, Goudas P, Alexopoulos D. Resistance to high-maintenance dose of prasugrel treated by ticagrelor: a case report. Platelets. 2013;24(3):239–41. https://doi.org/10.3109/09537104.2012.682104.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2018 Springer International Publishing AG, part of Springer Nature
About this entry
Cite this entry
Aguilar Pérez, M., AlMatter, M., Bäzner, H., Henkes, H. (2018). Anterior Communicating Artery Aneurysm: Incidental AcomA Aneurysm, pCONus-assisted Coil Occlusion, Intracerebral Hematoma due to Hyper-response on Aspirin and Clopidogrel. In: Henkes, H., Lylyk, P., Ganslandt, O. (eds) The Aneurysm Casebook. Springer, Cham. https://doi.org/10.1007/978-3-319-70267-4_42-1
Download citation
DOI: https://doi.org/10.1007/978-3-319-70267-4_42-1
Received:
Accepted:
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-70267-4
Online ISBN: 978-3-319-70267-4
eBook Packages: Springer Reference MedicineReference Module Medicine