Li W, Zhu W, Wang A, et al. - Reduction in thromboembolic events was achieved with platelet function monitoring–guided antiplatelet therapy in patients with unruptured intracranial aneurysm after stent placement. Such therapy significantly enhanced minor or minimal bleeding events but not major bleeding events in these patients.

• This randomized trial included 314 patients with unruptured intracranial aneurysm who had stent placement.

• Patients received either drug adjustment (platelet function monitoring–guided antiplatelet therapy [monitoring group]) or conventional treatment (without monitoring and drug adjustment [conventional group]).

• The composite frequency of ischemic stroke, transient ischemic attack, stent thrombosis, urgent revascularization, and cerebrovascular death within 7 days post-stent implantation was the primary outcome.

• In conventional and monitoring groups, the primary combined outcome occurred in 19 (12.1%) and 8 patients (5.1%), respectively (hazard ratio, 0.39).

• Lower occurrence frequency of ischemic stroke was evident in monitoring group vs conventional group (4.5% vs 12.1%; hazard ratio, 0.34), which drove the overall primary combined outcome.

• In the monitoring group and conventional group, the safety outcome (composite frequency of major, minor, or minimal bleeding within 1 month post-stent implantation) occurred in 7.0% and 1.9%, respectively, hazard ratio, 3.87.

• Frequency of minor or minimal bleeding events, but not of major bleeding events, differed significantly between groups (monitoring group vs conventional group, 6.4% vs 1.3%).