Role of light transmission aggregometry in predicting diffusion-weighted imaging lesions after stent-assisted coil embolization for intracranial aneurysms: a retrospective propensity score-matched study.

Object: The use of antiplatelet agents is essential in stent-assisted coiling (SAC) for the treatment of intracranial aneurysms, and the preoperative assessment of antiplatelet efficacy is important for reducing the risk of ischemic complications. Light transmission aggregometry (LTA) is used to assess antiplatelet drug efficacy, and we analyzed the association between patient background factors and perioperative complications in patients who underwent SAC using a retrospective analysis. Methods: Patients who underwent SAC for unruptured cerebral aneurysms from March 2017 to June 2024 were included. Dual antiplatelet therapy was administered at least 7 days before the procedure, and LTA was measured on the day of the procedure in all included patients and included in the main analysis. An additional preprocedural LTA measurement was available in 215 patients and was used to guide adjustment of antiplatelet therapy. The association between patient characteristics, ischemic complications, and postoperative diffusion-weighted imaging (DWI) positivity was evaluated. Propensity score matching, with the treatment period included as a covariate, was performed to investigate the association between adenosine diphosphate (ADP)-induced LTA values and DWI positivity. Results: A total of 1,021 unruptured aneurysms received endovascular treatment, of which 548 underwent SAC [453 Neuroform Atlas, 17 Enterprise, and 78 low-profile visualized intraluminal support (LVIS)]. The mean ADP-induced LTA value was 44.2 (range, 20-74). Symptomatic ischemic complications were present in two patients (0.4%). The overall rate of DWI-positive lesions was 52.7% (289/548). Propensity score matching with treatment period included as a covariate resulted in 152 matched pairs. Covariate balance improved after matching, with most covariates showing absolute standardized mean differences of <0.1, although some residual imbalance remained. ADP-induced LTA value was significantly higher in the DWI-positive group than in the DWI-negative group (45.89vs 43.09, Conclusion: Higher preoperative ADP-induced LTA values were associated with postoperative DWI-positive lesions after SAC. However, given the modest discriminative performance, ADP-induced LTA values should be interpreted as a supplementary reference rather than a standalone criterion for clinical decision-making.