Introduction Variability in responsiveness to conventional doses of dual antiplatelet therapy may contribute to ischemic or hemorrhagic complications seen after intracranial stenting. While there is evidence to suggest that testing reduces the rate of these complications, other data have demonstrated no improvement in outcomes. Therefore, the use of platelet function testing in neuroendovascular surgery remains controversial. Here we present the results of a retrospective analysis of 8 years of extracranial carotid artery stents, both with and without the use of platelet function testing.
Methods We performed a retrospective review of all patients undergoing extracranial carotid artery stenting between 2010 and 2017. We recorded patient demographics, the indication for stenting, the use of P2Y12 reaction unit (PRU) testing, and the associated PRU values for each patient. We reviewed these data for post procedural thromboembolic or hemorrhagic complications.
Results A total of 115 patients undergoing extracranial carotid artery stenting were included for retrospective review. 48 patients serve as historical controls while 67 consecutive patients since 2014 had prospective and perpetual adjustments in their dual antiplatelet regimens to obtain optimal platelet assays. A total of 1 ischemic (2%) and 0 hemorrhagic (0%) events were noted among those in whom testing was not used. A total of 3 ischemic (6%) and 1 hemorrhagic (2%) events were noted among patients with dual antiplatelet regimen adjustments. 36 of 67 (54%) patients demonstrated dynamic variability in responsiveness to clopidogrel. The use of platelet assays and management to ‘correct’ aberrant values was not associated with reduction of complications. Neither hypo nor hyper responsiveness to aspirin or clopidogrel was associated with increased risk of complications after extracranial stenting.
Conclusion The incidence of thromboembolic and hemorrhagic complications is unrelated to variability in response to clopidogrel therapy in patients undergoing endovascular stenting of the extracranial carotid artery. This was irrespective of the indication for stent placement, patient comorbidities, or number of stents used.
Disclosures M. Corriveau: None. A. Ahmed: None. D. Niemann: None. Y. Li: None.
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