Dual antiplatelet therapy after carotid artery stenting: trends and outcomes in a large national database
- 15 May 2020
- journal article
- research article
- Published by BMJ in Journal of NeuroInterventional Surgery
- Vol. 13 (1), 8-13
- https://doi.org/10.1136/neurintsurg-2020-016008
Abstract
Background While dual antiplatelet therapy (dAPT) is standard of care following carotid artery stenting (CAS), the optimal dAPT regimen and duration has not been established. Methods We canvassed a large national database (IBM MarketScan) to identify patients receiving carotid endarterectomy (CEA) or CAS for treatment of ischemic stroke or carotid artery stenosis from 2007 to 2016. We performed univariable and multivariable regression methods to evaluate the impact of covariates on post-CAS stroke-free survival, including post-discharge antiplatelet therapy. Results A total of 79 084 patients diagnosed with ischemic stroke or carotid stenosis received CEA (71 178; 90.0%) or CAS (7906; 10.0%). After adjusting for covariates, Conclusions Increased duration of post-CAS dAPT is associated with lower rates of readmissions for stroke, and with increased risk of hemorrhagic complications, particularly extracranial hemorrhage. The potential benefit of prolonging dAPT with regard to ischemic complications must be balanced with the corresponding increased risk of predominantly extracranial hemorrhagic complications.Keywords
This publication has 15 references indexed in Scilit:
- Long-Term Results of Stenting versus Endarterectomy for Carotid-Artery StenosisThe New England Journal of Medicine, 2016
- Executive Summary: Heart Disease and Stroke Statistics—2012 UpdateCirculation, 2012
- Stenting versus Endarterectomy for Treatment of Carotid-Artery StenosisThe New England Journal of Medicine, 2010
- Results of the Stent-Protected Angioplasty versus Carotid Endarterectomy (SPACE) study to treat symptomatic stenoses at 2 years: a multinational, prospective, randomised trialThe Lancet Neurology, 2008
- Long-Term Results of Carotid Stenting versus Endarterectomy in High-Risk PatientsThe New England Journal of Medicine, 2008
- 30 day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients: a randomised non-inferiority trialThe Lancet, 2006
- Dual Antiplatelet Regime Versus Acetyl-acetic Acid for Carotid Artery StentingCardioVascular and Interventional Radiology, 2006
- The Benefits of Combined Anti-platelet Treatment in Carotid Artery StentingEuropean Journal of Vascular and Endovascular Surgery, 2005
- Epidemiology of Ischemic Stroke Subtypes According to TOAST CriteriaStroke, 2001
- Endovascular versus surgical treatment in patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomised trialThe Lancet, 2001