Response to Letter by Kramer et al
We would like to thank Dr Kramer and colleagues for their interest in our article. With regard to aspirin and extended release dipyridamole, we are aware of its effectiveness for long-term stroke prevention, and we did mention that use of aspirin and dipyridamole beyond the postprocedure period (>4 weeks) could decrease the rate of long-term stroke events. The reason we did not mention this agent in the immediate postprocedure period is that there is virtually no published data on use of aspirin and dipyridamole in carotid stenting patients. We encourage Dr Kramer and colleagues to publish their data, and if their initial results can be confirmed by other groups, then a randomized study would be appropriate.
With regard to glycoprotein IIbIIIa inhibitors, this is a more complicated area. The use of these potent medications has been clearly linked with cerebral hemorrhages in some case series reports.1 It is likely that the hemorrhage rate will vary according to several variables, including postprocedure blood pressure control, presence of recent infarction, etc. At the current time, use of these agents on a routine basis is controversial.2 Careful, controlled studies of these agents in well-defined populations of carotid stent patients are needed.