CYP2C19 genotype-guided antiplatelet therapy to prevent thromboembolic events after stent-assisted coil embolization of unruptured intracranial aneurysms: a retrospective cohort study.

CYP2C19 genotyping guiding antiplatelet therapy post-SAC: 54.9% reduction in intracranial ischemic events

A retrospective study of 403 patients undergoing stent-assisted coil embolization (SAC) for unruptured intracranial aneurysm compared standard antiplatelet therapy (aspirin + clopidogrel without genotyping, n=220) vs CYP2C19 genotype-guided therapy (n=183). Intracranial ischemic events at 90 days were significantly reduced in the genotype-guided group: 4.9% vs 10.9% (relative risk reduction 54.9%, p=0.029). Systemic hemorrhagic events did not differ significantly between groups.

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CYP2C19 genotyping is already CPIC level A recommended for clopidogrel in interventional cardiology. This study extends its benefit to neurointerventions, where metabolizer status identically influences clopidogrel bioactivation. The retrospective design remains a limitation, but the cohort size and effect magnitude (55% RRR) are convincing.

Clinical impact: 3/3 · Evidence quality: 2/3 · Novelty: 1/2 · Sample size: 1/1 · Journal quality: 0/1 → Total: 7/10