Discussion This study showed a greater antithrombotic effect with clopidogrel than with aspirin treatment (historical control) in patients undergoing elective coil embolization for an unruptured cerebral aneurysm. The incidence of abnormal HIA assessed by MRI-DWI at 24 hours after coiling was PLX-4720 price significantly lower with clopidogrel than with aspirin treatment (p = 0.02),

and there were less periprocedural thromboembolic events with clopidogrel, although this was not statistically significant (p = 0.30). Management guidelines recommend surgical or endovascular intervention for the treatment of an unruptured intracranial aneurysm.[20–22] It is well established that thromboembolic events are the most common complications arising during or after click here aneurysm coiling.[11,12] Both the catheter and the coil mass are a potential ARN-509 cell line source for thrombus formation where clotting may occur.[11,13,14] A number of studies that used MRI-DWI for detection of early ischemia associated with Guglielmi detachable coils for the treatment of unruptured cerebral aneurysms showed a high rate of silent thromboembolic events, 42%,[13] 49%,[23] and 61%.[11] Although subsequent clinical outcomes of such events are rare,[11] antiplatelet agents are a safe option for reduction in the risk of thromboembolic events, asymptomatic or symptomatic.[11,13] In one study, compared with no

antiplatelet therapy, there was a significant reduction in thromboembolic events with intravenous aspirin (8.8% vs 17.6%; p = 0.028) with no increase in intraoperative bleeding during endovascular treatment of 247 patients with ruptured or unruptured cerebral aneurysms.[14] Similarly, a retrospective analysis of 10-year data from 369 patients who underwent elective coil embolization of unruptured cerebral aneurysms showed that compared with no antiplatelet treatment (16%), the rate of symptomatic thromboembolic events was significantly lower

in patients who received oral aspirin and/or Cisplatin chemical structure clopidogrel treatment (2%; p = 0.004), especially when administered pre- and post-procedure versus only post-procedure (1.9% vs 2.3%).[15] In addition, recent retrospective analyses of trials of oral antiplatelet treatment (clopidogrel,[24,25] aspirin,[25] or both[25] ) given prior to, but not following, coil embolization of unruptured cerebral aneurysms showed trends in reduction (7.4% vs 12.6%; p = 0.05)[24] or significant (2.1% vs 12.8%; p = 0.023)[25] reductions in perioperative thromboembolic complications, with no increase in hemorrhagic complication rates. It must be noted that these trials differed in design compared with each other and in comparison with our current trial, both were large trials that provided baseline stratified risks for thromboembolic complications. The availability of new consensus recommendations for reporting standards for endovascular treatment of intracranial aneurysms may facilitate the publication of trial results amenable for direct comparison.