Safety and Efficacy of Prasugrel Administration in Emergent Endovascular Treatment for Intracranial Atherosclerotic Disease

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  • Asai Katsunori
    Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
  • Taniguchi Masaaki
    Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  • Nakamura Hajime
    Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  • Tateishi Akihiro
    Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
  • Irizato Naoki
    Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
  • Okubata Hiroto
    Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
  • Fukuya Shogo
    Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
  • Yoshimura Kazuhiro
    Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
  • Yamamoto Kazumi
    Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan
  • Kishima Haruhiko
    Department of Neurosurgery, Osaka University Graduate School of Medicine, Suita, Osaka, Japan
  • Wakayama Akatsuki
    Department of Neurosurgery, Osaka Neurological Institute, Toyonaka, Osaka, Japan

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<p>Objective: Intracranial atherosclerosis disease (ICAD) is one of the most common causes of acute ischemic stroke. In endovascular treatment (EVT) for acute large vessel occlusion stroke-related ICAD, reocclusion of the recanalized artery due to in situ thrombosis is problematic. In this study, the safety and efficacy of prasugrel administration to avoid reocclusion of emergent EVT for ICAD was investigated.</p><p>Methods: All consecutive emergent EVTs for ICAD between September 2019 and December 2022 were included in this study. The procedures were divided into two groups as receiving periprocedural prasugrel (PSG group) or not (non-PSG group). Target vessel patency on follow-up, postprocedural intracranial hemorrhage (ICH), and clinical outcome were compared between PSG and non-PSG groups.</p><p>Results: A total of 27 procedures were included in this analysis. Nineteen target vessels were patent on follow-up and eight were non-patent. Fifteen patients received prasugrel (18.75 mg: 11 cases, 11.25 mg: 4 cases), and twelve patients did not receive prasugrel. The target vessel patency rate was better in the PSG group vs. non-PSG group (100% vs. 33.3%, respectively; p = 0.0002). The postprocedural ICH rate was not different between the groups (PSG: 40.0% vs. non-PSG: 25.0%; p = 0.68), and all ICHs were asymptomatic. Good clinical outcome (modified Rankin Scale score of 0 to 3 at discharge) was more frequent in the PSG group than that in the non-PSG group (66.7% vs. 16.7%, respectively; p = 0.019).</p><p>Conclusion: Prasugrel administration was significantly associated with target vessel patency and good clinical outcome after emergent EVT for ICAD without increasing the symptomatic ICH rate. Prasugrel administration might be safe and effective to avoid reocclusion during and after emergent EVT for ICAD.</p>

収録刊行物

  • 脳神経血管内治療

    脳神経血管内治療 17 (7), 125-131, 2023

    特定非営利活動法人 日本脳神経血管内治療学会

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