The Usefulness of Prasugrel as Rescue Medication in Neuroendovascular Therapy

OBJECTIVE: In neuroendovascular therapy, clopidogrel resistance and thrombosis are common problems. In such cases, we use prasugrel as rescue medication, and we clarified its usefulness. METHODS: We retrospectively investigated 199 consecutive cases of neuroendovascular therapy performed at our hospital from April 2016 to March 2018, and examined the safety and effectiveness of prasugrel. RESULTS: There were 14 cases of prasugrel administration: six cases of coil embolization for cerebral aneurysm, five cases of carotid artery stenting (CAS), and three other cases. The reasons for prasugrel administration were as follows: emergency stent use in four cases, intraoperative thrombosis in three cases, intra-stent thrombosis after CAS in three cases, and others in four cases. In all cases, it was used in combination with aspirin and the median duration of administration was 212 days. Regarding its safety, there was one hemorrhagic complication at the puncture site for which the involvement of prasugrel was unable to be excluded, but it was improved by conservative treatment and there was no major hemorrhage such as intracranial hemorrhage. Regarding its efficacy, in one case, the thrombus during coil embolization did not completely disappear after prasugrel administration and additional mechanical thrombolysis was required. However, no new thrombosis was observed during prasugrel administration in all 14 cases. CONCLUSION: Prasugrel may be useful as a rescue medication in neuroendovascular therapy.