Dual Antiplatelet Therapy With Clopidogrel and Aspirin in Symptomatic Carotid Stenosis Evaluated Using Doppler Embolic Signal Detection

Carotid artery stenting (CAS) may be an alternative to surgical endoarterectomy not only in highrisk patients. We report results in the endovascular treatment of carotid artery disease with up to 8 years' follow-up. In this retrospective study, we analysed data from 853 consecutive patients (946 arteries) treated for carotid artery stenosis between April 1999 and March 2007; 491 (52%) arteries were symptomatic and 455 (48%) were asymptomatic. Preprocedural evaluation of the patients was performed with echo Doppler, magnetic resonance angiography (MRA) or computed tomographic angiography (CTA) and a neurological examination. A cerebral protection device was used in 879 (92.9%) procedures. Anti-platelet therapy was administered before and after the procedure. All patients were included in a followup of up to 8 years. Technical success was achieved in 943 (99.6%) lesions. At 30 days, there was a 0.21% (n=2) death rate, a 0.42% major stroke rate, a 1.69% minor stroke/transient ischaemic attack (TIA) rate and a combined 2.32% TIA/stroke and death rate. During follow-up, echo Doppler evidenced restenosis in 39 (4.85%) cases; of these, only five, presenting restenosis >80%, were treated with an endovascular reintervention. At the long-term follow-up, two strokes (0.23%) were reported, which both occurred within the first 2 years. In our experience, carotid artery stenting seems to be a safe and effective treatment, providing satisfactory long-term clinical results.

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“…It has been demonstrated how the use of coplidogrel and ASA double anti-platelet therapy reduces the risk of embolization [26].…”

Section: Discussionmentioning

confidence: 99%

Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

et al. 2008

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“…This could partially be caused by the use of a dual antiplatelet therapy in our patients, which has recently been shown to significantly reduce asymptomatic embolization in this patient population. 7 The fact that all of our patients received dual antiplatelet therapy during follow-up limits the generalizability of our results to other patient populations, for instance those on antiplatelet monotherapy while waiting for CEA. Additional limitations of this study include the small sample size, as well as the relatively long delay between first symptoms and CAS, which has likely lead to an underestimation of the true risk of recurrent ischemia in our study.…”

Section: Discussionmentioning

confidence: 88%

Risk Factors for Early Recurrent Cerebral Ischemia Before Treatment of Symptomatic Carotid Stenosis

Kastrup

Ernemann²,

Nägele³

et al. 2006

Stroke

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Background and Purpose-In patients with a recently symptomatic carotid stenosis, surgical or interventional treatment is often delayed for weeks to months. Because therapy should be instituted as early as possible in patients at highest risk for recurrent ischemia, the aim of this study was to identify these individuals using clinical data and serial diffusion-weighted imaging (DWI). Methods-One hundred thirty-one patients (98 male; mean age 68Ϯ9 years) who had been referred to our department within 14 days (median; interquartile range, 4 to 36 days) after experiencing an ischemic event caused by a carotid stenosis were followed-up until carotid angioplasty and stenting. Risk factors predicting recurrent transient ischemic attack, stroke, or new DWI lesions were examined. Results-During a median follow-up period of 7 days (interquartile range, 5 to 13 days) no patient experienced a stroke, 4 patients (3.1%) developed a hemispherical transient ischemic attack, and in 15 patients (12%) new asymptomatic DWI lesions were present in the territory of the treated artery. Multivariable regression analysis revealed that motor symptoms (odds ratio, 5.6; 95% CI, 1.2 to 26.3; PϽ0.05) or the presence of a contralateral carotid occlusion (odds ratio, 4.6; 95% CI, 1.0 to 20.4; PϽ0.05) were significant independent predictors of further cerebral ischemic events before carotid angioplasty and stenting. Conclusions-In patients with a recently symptomatic carotid stenosis, the risk of early recurrent ischemia is highest in those with motor symptoms and in those with a contralateral carotid occlusion. In these high-risk patients urgent preventive treatment might be warranted. (Stroke. 2006;37:3032-3034.)

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“…Although a number of small or pilot studies suggest a benefit of the addition of clopidogrel to aspirin for a period (1-3 months) immediately after ischemic stroke, [42][43][44] this more aggressive antiplatelet intervention is not an endorsed standard of care. As described below, the long-term use of this antiplatelet combination has been consistently associated with a higher risk of hemorrhagic complications.…”

Section: No Blood On the Ct Scan Results Back In >8 Hours From Symptmentioning

confidence: 99%

Management of ischemic stroke: Part 1. Emergency room management

Lu-Emerson

Likosky

Amin

et al. 2010

Journal of Hospital Medicine

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BACKGROUND:Acute ischemic stroke is commonly encountered by the hospitalist. There have been dramatic changes in our ability to care for these patients acutely. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) primary stroke center certification has become progressively more important to institutions nationally and includes many aspects of initial evaluation and treatment.PURPOSE:Acute treatment involves the rapid assimilation of patient characteristics, laboratory results, and imaging results. There are a growing number of potential acute therapies with a range of risk, benefit, necessary time windows, and specific eligibility criteria.DATA SOURCES:Primary trials, current guidelines.CONCLUSIONS:The hospitalist is well‐positioned to play a major role in the treatment of stroke patients as well as the systems work that aids in the management of this population. Journal of Hospital Medicine 2010;5:33–40. © 2010 Society of Hospital Medicine.

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Dual Antiplatelet Therapy With Clopidogrel and Aspirin in Symptomatic Carotid Stenosis Evaluated Using Doppler Embolic Signal Detection

Abstract: Background-Evidence

Cited by 679 publications

References 45 publications

Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

Carotid artery stenting: a single-centre experience with up to 8 years’ follow-up

Risk Factors for Early Recurrent Cerebral Ischemia Before Treatment of Symptomatic Carotid Stenosis

Management of ischemic stroke: Part 1. Emergency room management

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