基于快速CYP2C19基因检测的急性基底动脉闭塞患者双联抗血小板治疗1例报道(A Case Report of Dual Antiplatelet Therapy for Acute Basilar Artery Occlusion Based on Rapid CYP2C19 Gene Detection)

本文介绍了1例基于基因检测的后循环缺血介入治疗后抗血小板治疗的患者情况。该例患者为老年女性，基底动脉中段闭塞所致急性缺血性卒中，发病3 h内入院，给予静脉溶栓后桥接介入治疗，治疗后恢复较好（NIHSS评分从入院时的11分降至出院时的2分）。为个体化选择患者的抗血小板治疗方案，在介入治疗后进行细胞色素P450酶家族2亚家族C成员19（cytochrome P450 family 2 subfamily C member 19，CYP2C19）基因检测，显示为中间代谢型，提示患者可能存在氯吡格雷抵抗，选择替格瑞洛联合阿司匹林双联抗血小板方案进行3个月的抗血小板治疗，之后根据患者随访情况调整用药。出院后2个月随访时患者预后良好且未出现出血表现。 Abstract: This article described a case of a patient with antiplatelet therapy after interventional therapy for posterior circulation ischemia based on gene detection. The patient was an elderly female with acute ischemic stroke caused by middle segment occlusion of the basilar artery. She was admitted within 3 hours of onset and received intravenous thrombolysis followed by bridging interventional therapy. After treatment, the patient recovered well (NIHSS score decreased from 11 points at admission to 2 points at discharge). In order to individualize the selection of the patient’s antiplatelet therapy regimen, cytochrome P450 family 2 subfamily C member 19 (CYP2C19) gene detection was performed after interventional therapy, which showed an intermediate metabolism type, indicating that the patient may have clopidogrel resistance. Therefore, the dual antiplatelet therapy regimen of ticagrelor combined with aspirin was selected for 3 months for antiplatelet therapy, and then the medication was adjusted according to the patient’s follow-up. At two months of follow-up after discharge, the prognosis was good and there were no bleeding manifestations.