| Objective: To evaluate the efficacy of oral aspirin and clopidogrel dual antiplatelet therapy in patients with intracranial artery stenosis treated with stent implantation and stent-assisted embolization of unruptured intracranial arteries during the perioperative period by thromboelastogram(TEG),and to preliminarily analyze the clinical risk factors of drug resistance.Methods:A retrospective analysis was conducted on the clinical data of patients who were hospitalized in the Department of Neurosurgery,the First Affiliated Hospital of Dalian Medical University from January 2022 to December 2022 and were diagnosed with intracranial atherosclerotic stenosis or unruptured intracranial aneurysm by CTA or DSA in our hospital,and underwent intracranial artery stent placement or stent-assisted aneurysm embolization and TEG examination in our hospital.The patient’s gender,age,smoking history,drinking history,past medical history(cardiovascular and cerebrovascular diseases,hypertension,diabetes),body mass index(BMI),TEG related indicators,blood routine,blood glucose,blood lipid,coagulation,operation duration,intraoperative medication,and previous use of antiplatelet drugs were collected.A total of 104 patients were enrolled,including 64 patients in the unruptured intracranial aneurysm group and 40 patients in the intracranial artery stenosis group.All patients took aspirin 75mg/d and clopidogrel 100mg/d regularly for 3 days before surgery.TEG was performed before admission and on the first day after surgery.SPSS26.0 statistical software was use to analyze the date,Independent sample t test was used for comparison between the two groups,measurement data were described by mean and standard deviation(X±S),count data were described by frequency and rate,Chi-square test was used for comparison between groups,and Fisher test was used when theoretical frequency was less than 5.P < 0.05 was considered statistically significant.The two groups were further grouped according to the occurrence of drug resistance.The independent sample t test was used for comparison between the two groups,and then Logistic regression analysis was performed on the independent variables with statistical significance in univariate analysis with resistance as the dependent variable.Results: There were no significant differences in gender,smoking history,body mass index(BMI),history of hypertension,history of coronary heart disease,smoking history,previous medication history,PT and APTT between the two groups(P > 0.05).Compared with the aneurysm group,the patients in the stenosis group were older,had higher prevalence of diabetes and hyperlipidemia,lower platelet count,and higher blood glucose level on admission(P < 0.05).The aspirin inhibition rate in the aneurysm group was 89.13%±10.56%,which was significantly higher than 56.93%±28.38% in the stenosis group,and the difference was statistically significant(P < 0.05).The clopidogrel inhibition rate in the aneurysm group was 44.66%±30.03%.Compared with the stenosis group,the clopidogrel inhibition rate in the stenosis group was 36.22%±24.60%,and the difference was not statistically significant(P > 0.05).In this study,the good effect rate of aspirin in the aneurysm group was 87.5%(56/64),which was higher than 20%(8/40)in the stenosis group,and the difference was statistically significant(P < 0.05).The good effect rate of clopidogrel in the aneurysm group was 20%(16/64),which was higher than 0%(0/40)in the stenosis group.The difference was statistically significant(P < 0.05).No patients in the aneurysm group had aspirin resistance,20%(8/40)patients in the stenosis group had aspirin resistance,37.5%(24/64)patients in the aneurysm group had clopidogrel resistance,and 60%(24/40)patients in the stenosis group had aspirin resistance,the difference was not statistically significant(P > 0.05).Univariate analysis showed that the age,history of diabetes and blood glucose level of the resistant group were higher than those of the non-resistant group in the aneurysm group,and the differences were statistically significant(P < 0.05).Logistic regression analysis showed that age and blood glucose level were independent risk factors for drug resistance,OR value and P value were: age: OR=1.206,P=0.003;Blood glucose level: OR=1.544,P=0.008;At the same time,univariate analysis showed that the age,history of diabetes and blood glucose level of patients in the resistance group were higher than those in the non-resistance group in the stenosis group,and the differences were statistically significant(P < 0.05).Logistic regression analysis showed that age and blood glucose level were independent risk factors for drug resistance,OR value and P value were: age: OR=1.250,P=0.026;Blood glucose level: OR=1.864,P=0.003;Conclusions:1.There is heterogeneity between IA and ICAS.In this study,TEG detection can show that there are differences in the efficacy of anti-platelet aggregation therapy and drug resistance between the two cerebrovascular diseases.Under the condition of taking standard dose of dual anti-platelet drugs for 3 days,the inhibitory effect of aspirin and clopidogrel on platelets in IA group is better than that in ICAS group.And the drug resistance rate is lower.In both IA group and ICAS group,the inhibitory effect of aspirin on platelets is better than that of clopidogrel,and the incidence of drug resistance of aspirin is less than that of clopidogrel.2.The occurrence of aspirin and clopidogrel resistance is closely related to diabetes,high blood glucose level and advanced age.The difference of antiplatelet drug efficacy and drug resistance between IA patients and ICAS patients may be based on the above risk factors.3.This study suggests that patients with ICAS may need a higher dose or longer duration of dual antiplatelet drugs or change of antiplatelet drugs to achieve the same anti-platelet aggregation efficacy compared with patients with IA.It may help clinicians to customize the anti-platelet aggregation therapy for patients with different cerebrovascular diseases before stent intervention. |
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