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P180 Results of tailored antiplatelet therapy in carotid artery stenting
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  1. Pavol Vigláš1,2,
  2. Filip Cihlář3,
  3. Vojtech Smolka3,
  4. Jan Raupach2,
  5. Alex Hejčl4,
  6. David Cernik5
  1. 1Masaryk Hospital – J.E. Purkinje University and KZ a.s., Dept. of Radiology, Ústí nad Labem, Czech Republic., University hospital Hradec Králové – Faculty of medicine, Dept. of Radiology, Hradec Králové, Czech Republic
  2. 2University Hospital Hradec Králové – Faculty of medicine, Dept. of Radiology, Hradec Králové, Czech Republic
  3. 3Masaryk Hospital – J.E. Purkinje University and KZ a.s., Dept. of Radiology, Ústí nad Labem, Czech Republic
  4. 4Masaryk Hospital – KZ a.s., Dept. of Neurosurgery, Ústí nad Labem, Czech Republic
  5. 5Masaryk Hospital – KZ a.s., Dept. of Neurology, Ústí nad Labem, Czech Republic

Abstract

Introduction Carotid stenting requires dual antiplatelet therapy to effectively prevent thromboembolic complications. However, resistance to clopidogrel, a key component of this therapy, may lead to persistent risk of these complications.

Aim of Study The aim of this study was to determine, if the implementation of routine platelet function testing and adjusting therapy was associated with lower incidence of thromboembolic complications and death.

Methods All consecutive patients treated with carotid artery stenting in a single institution over 8 years were enlisted in a retrospective study. Platelet function testing was performed and efficient antiplatelet therapy was set before the procedure. Incidence of procedure-related stroke or death within periprocedural period was assessed. The results were evaluated in relation to the findings of six prominent randomized control trials.

Results A total of 241 patients were treated for carotid stenosis, seven patients undergo CAS on both sides over time. There was 138 symptomatic and 110 asymptomatic stenoses. Five thromboembolic complications occurred, four of them [1,61%] were procedure-related. Two patients died because of procedure-related stroke [0,82%]. Incidence of procedure-related stroke or death was significant lower compared to the results of CREST study [2,01% vs. 4,81%, P=0,0243] in the entire cohorts, and to the results of ICSS study in the symptomatic cohorts [2,86% vs. 7,37%, P=0,0243], respectively.

Conclusion Tailored antiplatelet therapy in carotid stenting is safe and seems to be related with lower incidence of procedure-related death or stroke rate. To assess whether platelet function testing-guided antiplatelet therapy is superior to standard dual antiplatelet therapy should be considered.

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