Prediction of perioperative ischemic events in flow diverter implantation using the adenosine diphosphate-induced platelet aggregation level system

Platelet reactivity is associated with perioperative complications during flow diverter (FD) implantation. Our study aimed to evaluate the association between adenosine diphosphate-induced platelet aggregation level (APAL) a platelet reactivity scoring system using light transmission methods and ischemic complications after FD implantation. This retrospective study included 47 patients who underwent FD implantation for cerebral aneurysms between September 2020 and December 2023 at our institution and who were taking two or more antiplatelet agents before the procedure. Platelet reactivity was assessed using APAL scoring and VerifyNow, with evaluations conducted preoperatively, 1–3 days postoperatively, 1 month postoperatively, and at the time of ischemic complications. Ischemic complications occurred in four patients (8.5 %). The correlation coefficient between APAL and the P2Y12 reaction units (PRU) measured over the entire period was r = 0.553 ( p < 0.001). Preoperative APAL values were significantly high in patients with ischemic complications ( p = 0.024). The optimal cutoff APAL value calculated from the receiver operating characteristic curve, was 6.6. The APAL system exhibited a moderate correlation with PRU measurements. As a fully automated test, APAL is characterized by fewer manual errors than conventional methods. Therefore, APAL may be useful for evaluating antiplatelet function during FD implantation.