This paper, written by members of the board directors and the advisory board, brings a new light on a major test used to prevent complications in anterior circulation Pipeline placement. The P2Y12 tests the responsiveness to blood thinning medicine, which, based on the results of the test, can help add another level of safety before undergoing endovascular placement of the flow diverting Pipeline device. Before this paper was published, recent reports suggest that thromboembolic complications are associated with Pipeline embolization device (PED) placement cluster in P2Y12 hyporesponders. This research paper brings a new light on the overall usefulness of this test involving hyporesponses. It concluded that P2Y12 hyporesponse (PRU>200) is not associated with increased periprocedural complications in a contemporary series of patients undergoing anterior circulation Pipeline embolization device placement. Titration of antiplatelet medications to P2Y12 >200 remains unindicated and may increase the risk of hemorrhagic complications. A very successful and interesting case that follows the results of the research is seen in the angiographic images below. This case is of a patient who underwent a successful treatment of a 26 mm ophthalmic aneurysm with a preprocedural P2Y12 of 252.
Left to right: Pre-embolization, post-Pipeline embolization device, and post-adjunctive coiling DSA
Read the full research paper by following this link: http://jnis.bmj.com/content/early/2016/09/06/neurintsurg-2016-012618.long