Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Child's Nervous System
Published in: Child's Nervous System 4/2017

01-04-2017 | Case Report

Optimal pediatric dosing of anti-platelet agents for pipeline stent embolization —a case report and review of the literature

Authors: Mary In-Ping Huang Cobb, Ali R. Zomorodi, Erik F. Hauck, Tony P. Smith, L. Fernando Gonzalez

Published in: Child's Nervous System | Issue 4/2017

Login to get access

Abstract

Background

Various strategies are emerging for dosing antiplatelet therapies in preparation for pipeline stent embolization in adults. Hyper-response is associated with hemorrhagic complications. Hypo-response is associated with thromboembolic events. Dosing of antiplatelet agents is highly variable, with little consensus among experts for adults–and even more so for children. To date, pipeline stents have been deployed in 11 pediatric patients, ages 4–15. A variety of clopidogrel and aspirin dosing regimens have been used, with response tested in only three patients, who were all therapeutic. Thrombotic events occurred in two patients, neither of whom were tested.

Case

We describe here the first case of a hemorrhagic complication in a hyper-responsive pediatric patient undergoing placement of a pipeline stent.

Discussion

As the use of endovascular therapies requiring dual anti-platelet agents becomes more established, there is an increasing need to develop titration protocols that minimizes the risk of thrombotic and hemorrhagic events.
Literature
1.
Goh C, Churilov L, Mitchell P et al (2013) Clopidogrel hyper-response and bleeding risk in neurointerventional procedures. AJNR Am J Neuroradiol 34:721–726CrossRefPubMed
2.
Kashiwazaki D, Kuwayama N, Akioka N et al (2014) The roles and issues of P2Y12 percent inhibition assessed by VerifyNow assay for patients undergoing neurointervention: a prospective study. J Stroke Cerebrovasc Dis 23:1830–1836CrossRefPubMed
3.
Delgado Almandoz JE, Crandall BM, Scholz JM et al (2013) Pre-procedure P2Y12 reaction units value predicts perioperative thromboembolic and hemorrhagic complications in patients with cerebral aneurysms treated with the pipeline embolization device. J Neurointerv Surg 5(Suppl 3):iii3–ii10CrossRefPubMed
4.
Delgado Almandoz JE, Crandall BM, Scholz JM et al (2014) Last-recorded P2Y12 reaction units value is strongly associated with thromboembolic and hemorrhagic complications occurring up to 6 months after treatment in patients with cerebral aneurysms treated with the pipeline embolization device. AJNR Am J Neuroradiol 35:128–135CrossRefPubMed
5.
Chalouhi N, Zanaty M, Jabbour PM et al (2014) Intracerebral hemorrhage after pipeline embolization: management of antiplatelet agents and the case for point-of-care testing—case reports and review of literature. Clin Neurol Neurosurg 124:21–24CrossRefPubMed
6.
Daou B, Starke RM, Chalouhi N et al (2016) P2Y12 reaction units: effect on hemorrhagic and thromboembolic complications in patients with cerebral aneurysms treated with the pipeline embolization device. Neurosurgery 78:27–33
7.
Stone GW, Witzenbichler B, Weisz G et al (2013) Platelet reactivity and clinical outcomes after coronary artery implantation of drug-eluting stents (ADAPT-DES): a prospective multicentre registry study. Lancet 382:614–623CrossRefPubMed
8.
Buck ML (2010) Clopidogrel for platelet inhibition in pediatric patients pediatric pharmacotherapy. Pediatr Pharm 16(5). www.medscape.com/viewarticle/723239_10. Accessed November 10, 2015
9.
Li JS, Yow E, Berenzy KY et al (2008) Dosing of clopidogrel for platelet inhibition in infants and young children: primary results of the platelet inhibition in children on clopidogrel (PICOLO) trial. Circulation 117:553–559CrossRefPubMed
10.
11.
Holmes DR Jr, Dehmer GJ, Kaul S et al (2010) Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons; writing committee members. ACCF/AHA clopidogrel clinical alert: approaches to the FDA "boxed warning": a report of the American College of Cardiology Foundation task force on clinical expert consensus documents and the American Heart Association. Circulation 122:537–557CrossRefPubMed
12.
Vasan R, Patel J, Sweeney JM et al (2013) Pediatric intracranial aneurysms: current national trends in patient management and treatment. Childs Nerv Syst 29:451–456CrossRefPubMed
13.
Liang J, Bao Y, Zhang H, Wrede KH, Zhi X, Li M et al (2009) The clinical features and treatment of pediatric intracranial aneurysm. Childs Nerv Syst 25:317–324CrossRefPubMed
14.
Navarro R, Brown BL, Beier A et al (2015) Flow diversion for complex intracranial aneurysms in young children. J Neurosurg Pediatr 15:276–281CrossRefPubMed
15.
16.
Martin AR, Cruz JP, O'Kelly C et al (2015) Small pipes: preliminary experience with 3-mm or smaller pipeline flow-diverting stents for aneurysm repair prior to regulatory approval. AJNR Am J Neuroradiol 36:557–561CrossRefPubMed
17.
Saatci I, Yavuz K, Ozer C et al (2012) Treatment of intracranial aneurysms using the pipeline flow-diverter embolization device: a single-center experience with long-term follow-up results. AJNR Am J Neuroradiol 33(8):1436–1446CrossRefPubMed
18.
D'Urso PI, Lanzino G, Cloft HJ et al (2011) Flow diversion for intracranial aneurysms. A review. Stroke 42:2363–2368CrossRefPubMed
19.
Piano M, Valvassori L, Quilici L et al (2013) Midterm and long-term follow-up of cerebral aneurysms treated with flow diverter devices: a single-center experience. J Neurosurg 118:408–416CrossRefPubMed
20.
Munich SA, Tan LA, Keigher KM et al (2014) The pipeline embolization device for the treatment of posterior circulation fusiform aneurysms: lessons learned at a single institution. J Neurosurg 121:1077–1084CrossRefPubMed
21.
de Barros FM, Castro RN, Lundquist J et al (2011) The role of the pipeline embolization device for the treatment of dissecting intracranial aneurysms. AJNR Am J Neuroradiol 32:2192–2195CrossRef
22.
Cinar C, Bozkaya H, Oran I (2013) Endovascular treatment of cranial aneurysms with the pipeline flow-diverting stent: preliminary mid- term results. Diagn Interv Radiol 19:154–164PubMed
23.
Abla AA, Zaidi HA, Crowley RW et al (2014) Optic chiasm compression from mass effect and thrombus formation following unsuccessful treatment of a giant supraclinoid ICA aneurysm with the pipeline device: open surgical bailout with STA-MCA bypass and parent vessel occlusion. J Neurosurg Pediatr 14:31–37CrossRefPubMed
24.
Vargas SA, Diaz C, Herrera DA et al (2015) Intracranial aneurysms in children: the role of stenting and flow-diversion. J Neuroimaging 00:1–5
25.
Zarzecka A, Gory B, Turjman F (2014) Implantation of two flow diverter devices in a child with a giant, fusiform vertebral artery aneurysm: case report. Pediatr Neurol 50:185–187CrossRefPubMed
26.
Ryu DS, Hong C-K, Sim YS et al (2010) Anti-platelet drug resistance in the prediction of thromboembolic complications after neurointervention. J Korean Neurosurg Soc 48:319–324CrossRefPubMedPubMedCentral
27.
Campo G, Fileti L, de Cesare N et al (2010) Long-term clinical outcome based on aspirin and clopidogrel responsiveness status after elective percutaneous coronary intervention. J Am Coll Cardiol 56:1447–1455CrossRefPubMed
28.
Aradi D, Komocsi A, Vorobcsuk A et al (2010) Prognostic significance of high on-clopidogrel platelet reactivity after percutaneous coronary intervention: systematic review and meta-analysis. Am Heart J 160:543–551CrossRefPubMed
Metadata
Title
Optimal pediatric dosing of anti-platelet agents for pipeline stent embolization —a case report and review of the literature
Authors
Mary In-Ping Huang Cobb
Ali R. Zomorodi
Erik F. Hauck
Tony P. Smith
L. Fernando Gonzalez
Publication date
01-04-2017
Publisher
Springer Berlin Heidelberg
Published in
Child's Nervous System / Issue 4/2017
Print ISSN: 0256-7040
Electronic ISSN: 1433-0350
DOI
https://doi.org/10.1007/s00381-016-3311-z

Other articles of this Issue 4/2017

Child's Nervous System 4/2017 Go to the issue

Cover Editorial

Early history of neurofibromatosis type 2 and related forms: earliest descriptions of acoustic neuromas, medical curiosities, misconceptions, landmarks and the pioneers behind the eponyms

Case Report

Syringomyelia caused by an arachnoid web in a patient with shunted Dandy-Walker malformation

Technical Notes

Frontal burr hole approach for neuroendoscopic resection of craniopharyngioma with the NICO Myriad device: report of two cases

Case Report

Transcardiac migration of ventriculoperitoneal shunt requiring open cardiac surgery: case report and review of the literature

Case Report

Somatosensory reflex seizures in a child with epilepsy related to novel SCN1A mutation

Original Paper

A comparison of clinicopathological features and surgical outcomes between pediatric skull base and non-skull base meningiomas