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Introduction CYP2C19 polymorphisms impair clopidogrel metabolism and may increase thrombotic risk after neuroendovascular procedures. While point-of-care genotyping correlates with thrombotic risk in cardiology, its concordance with VerifyNow PRU in neuroendovascular patients is unclear. We evaluated the feasibility of outpatient genotyping and its impact on postprocedural antiplatelet management.Methods Prospective study of 30 patients undergoing elective neuroendovascular procedures, including aneurysm embolization, carotid/vertebral stenting, and venous sinus stenting, at a single center (Oct 2025-Jan 2026). All underwent preoperative CYP2C19 genotyping using the Genomadix Cube (*1 [wild-type], *2/*3 [loss-of-function], *17 [gain-of-function]) and VerifyNow PRU testing on clopidogrel. Thromboelastography with platelet mapping was available in 26. Discordance was defined as LOF carriers with PRU <100 or non-carriers with PRU >180. High on-treatment platelet reactivity (HTPR) was PRU >208. Antiplatelet management and 30-day outcomes were recorded.Results Diplotypes included *1/*1 (40%), *1/*17 (23%), *1/*2 (20%), *2/*17 (13%), and *17/*17 (3%), with 33% carrying a LOF allele. Mean PRU was 114.8 (SD 63.8). Discordance occurred in 30%: 6 LOF carriers had PRU <100, and 3 non-carriers had PRU >180. All LOF carriers were intermediate metabolizers; no patient carried two LOF alleles. HTPR occurred in 20% of carotid/vertebral stents and 28.6% of venous sinus stents. Antiplatelet therapy changed in 40%: 7 switched (4 ticagrelor, 3 prasugrel) and 5 discontinued. Switched patients had higher PRU than unchanged patients (median 193 vs 105, p=0.032), though 3 had PRU <150. PRU and TEG % inhibition correlated moderately (Spearman rho = -0.53, p=0.006) with poor binary agreement (38.5%). No thrombotic or hemorrhagic events occurred.Conclusions Point-of-care CYP2C19 genotyping is feasible and influenced antiplatelet management. Favorable genotypes may support clopidogrel use, while LOF alleles may prompt ticagrelor or prasugrel. Genotype alone does not assess compliance, and discordance with functional testing warrants caution. Both P2Y12 and genotype results provide beneficial information.Disclosures A. Naqvi: None. A. Gajjar: None. T. Sorenson: None. A. Custozzo: None. H. Greene: None. N. Field: None. A. Paul: None.Abstract E-101 Figure 1Genotype-platelet reactivity concordance. Dashed line indicates HTPR threshold (PRU > 208)Abstract E-101 Figure 2Preoperative PRU by neuroendovascular procedure type