Dual Antiplatelet Therapy in Neuroendovascular Procedures

Dual antiplatelet therapy is currently used in clinical practice to prevent thrombotic events during and after neuroendovascular procedures.

Despite antiplatelet therapy, a significant number of patients show insufficient platelet inhibition, as measured by laboratory tests. These patients are at greater risk of developing thrombotic events than are patients sensitive to the treatment. This phenomenon is known as "antiplatelet drug resistance". The mechanisms that influence the individual response to antiplatelet therapy are not completely understood and are likely to be multifactorial.

Several platelet function tests have been developed to monitor antiplatelet therapy and may assist in adjusting it to improve outcomes in patients with antiplatelet drug resistance. Nevertheless, the optimal management for these patients has not yet been established. This chapter summarizes information on the available antiplatelet drugs currently used in neuroendovascular procedures, the commonly used tools for platelet function testing and the potential mechanisms underlying suboptimal platelet inhibition by aspirin and clopidogrel.

Keywords: Antiplatelet therapy, aspirin, neuroendovascular procedure, platelet function test, P2Y12 receptor antagonists.