Abstract TP140: Impact of Pre-procedural Antiplatelet Therapy on Vascular Events After Carotid Artery Stenting: Investigation on Devices and Anti-platelet Therapy for Carotid Artery Stenting (IDEALCAST)
Background and Purpose: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended for a standard pre-procedural management for carotid artery stenting (CAS). However, impact of other pre-procedural antiplatelet drug on vascular events after CAS is still unknown.
Methods: In a prospective, multicenter, observational study, we analyzed data from 934 patients underwent elective CAS for > 50 % stenosis in symptomatic or > 80% stenosis in asymptomatic carotid arteries. Data on pre-procedural antiplatelet drugs was obtained at patients’ enrollment, and all patients were followed for 1 year after the stenting. The primary endpoint was the composite of death, any stroke, transient ischemic attack, myocardial infarction, and serious systemic bleeding.
Results: Of the 934 patients (818 men, 72 ± 7 years old), 476 patients were treated with aspirin and clopidogrel (51.0%, A+CLP group), 162 with aspirin and cilostazol (17.3%, A+CSZ group), 62 with clopidogrel and cilostazol (6.6%, CLP+CSZ group), 118 with asprin, clopidogrel and cilostazol (12.6%, TAPT group), and 116 with other combinations (12.4%, Other group). As patients background, a history of ischemic stroke was more frequent in A+CSZ and CLP+CSZ groups, and a history of ischemic heart disease or revascularization was more frequent in A+CLP and TAPT groups than in other groups. There was no significant difference in other factors. Incidences of primary endpoint were as follows: 12.6% in A+CLP, 5.6% in A+CSZ, 8.1% in CLP+CSZ, 14.4% in TAPT, and 15.5% in Other group. In multivariate analysis, combination of aspirin and cilostazol was associated with lower risk for primary endpoint compared with aspirin and clopidogrel (hazard ratio, 0.39; 95% confidence interval, 0.18 to 0.75, P=0.004).
Conclusions: Combination of aspirin and cilostazol can decrease the risk of vascular events or death after CAS. A prospective randomized controlled trial is necessary to clarify the effect of pre-procedural antiplatelet therapy on vascular events after CAS.
- © 2012 by American Heart Association, Inc.