| Significance of Clopidogrel Resistance Related to the Stent-Assisted Angioplasty in Patients with Atherosclerotic Cerebrovascular Disease. |
| Gyoung Jun Rho, Woo Ram Shin, Tae Sik Kong, Min Sun Kim, Chang Ju Lee, Byung Hee Lee |
1Department of Neurosurgery, Presbyterian Medical Center, Jeonju, Korea.
2Department of Radiology, Eulji University Hospital, Daejeon, Korea. mdbhlee@eulji.ac.kr |
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| ABSTRACT |
OBJECTIVE
To evaluate the prevalence and risk factors of clopidogrel resistance, and association between thromboembolic complications and clopidogrel resistance in patient with stent-assisted angioplasty for atherosclerotic cerebrovascular disease.
METHODS
Between September 2006 and June 2008, clopidogrel resistance test was performed on 41 patients who underwent stent-assisted angioplasty for atherosclerotic cerebrovascular disease. It was performed before drug administration and about 12 hours after drug administration (loading dose : 300 mg, maintain dose : 75 mg). Two patients were excluded, and 41 patients were included (mean : 67.59+/-7.10 years, age range : 41-79). Among 41 patients, 18 patients had intracranial lesions, and 23 had extracranial lesions. We evaluated the prevalence, risk factors and complications related to clopidogrel resistance.
RESULTS
Twenty-one patients (51.2%) showed clopidogrel resistance [intracranial : 10 patients (55.6%), extracranial : 11 patients (47.8%)] and no clopidogrel resistance was seen in 20 patients. Hypercholesterolemia was an indepedent risk factor of clopidogrel resistance. Stent-assisted angioplasty was technically successful in all patients, but acute in-stent thrombosis occurred in 5 patients with intracranial lesions (4 patients with clopidogrel resistance and 1 without clopidogrel resistance). Acute thrombi were completely lysed after intra-arterial infusion of abciximab.
CONCLUSION
There was relatively high prevalence of clopidogrel resistance in patients with atherosclerotic cerebrovascular disease. Hypercholesterolemia was an independent predictive factor of clopidogrel resistance.
Acute in-stent thrombosis was more frequently seen in the clopidogrel resistant group. Therefore, clopidogrel resistance test should be performed to avoid thromboembolic complications related to stent-assisted angioplasty for atherosclerotic cerebrovascular disease, especially patients with hypercholeterolemia and intracranial lesion. |
| Key Words:
Clopidogrel; Resistance; Neurointervention; Stent |
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