High On-Treatment Platelet Reactivity in Peripheral Arterial Disease: A Pilot Study to Find the Optimal Test and Cut Off Values

Abstract

Objective/Background: The objective was to investigate renal outcomes following endovascular repair of thoraco-abdominal aortic aneurysms (TAAA) comparing fenestrations with branches for the renal arteries. Methods: Renal outcomes following TAAA endovascular repair performed with renal branches were collected from five high volume European centers and compared with renal outcomes following TAAA endovascular repair performed with renal fenestrations at one center. Renal re-intervention and occlusion rates, and freedom from any renal outcome and death were analyzed by patient and target vessel. Estimated glomerular filtration rate (eGFR) was calculated and collected pre-operatively and at the last available follow up. Results: In total, 449 patients were included in this retrospective study (235 treated with branched devices [BEVAR] and 214 with fenestrated devices [FEVAR]). Altogether, 856 renal vessels were analyzed (445 perfused by branches and 411 by fenestrations). Both groups were comparable except for sex and smoking habits. Technical success rates were 95% and 99%, respectively. Mean 6 SD follow up was 19 6 18 months after BEVAR and 24 6 20 months after FEVAR. During follow up, renal re-intervention rates were similar in both groups (4.7% vs 5.2%). The renal occlusion rate was significantly higher following BEVAR (9.6% vs 2.3%; P < .01), and the 2 year freedom for renal occlusion rate was 90.4% (SE 85.8%-95.3%) following BEVAR and 97.1% (SE 94.6%-99.7%) following FEVAR (P < .01). During follow up, a 12% median decrease in eGFR was observed following BEVAR versus 9% following FEVAR (non-significant). The 2 year survival rates were 73.4% (SE 66.6%-80.9%) and 81.8% (SE 76.1%-87.9%) following BEVAR and FEVAR, respectively. Conclusion: Mid-term renal outcomes following endovascular repair of TAAA are satisfactory. Endograft designs incorporating renal fenestrations rather than renal branches are associated with significantly lower occlusion rates. A prospective trial is now required to confirm these results.

On-Treatment Platelet Reactivity is a Predictor of Adverse Events in Peripheral Artery Disease Patients Undergoing Percutaneous Angioplasty

“…20 Recently, two studies have demonstrated an association between aspirin resistance detected by VerifyNow and clopidogrel resistance detected by Ver-ifyNow and VASP and thrombotic complication in a significantly lower number of PAD patients. 17,20,21 The present results demonstrate that in PAD patients, not only HPR by ADP, but also HPR by AA were found to be independent predictors of death in PAD patients treated by PTA.…”

CYP2C19 Polymorphism is Associated With Amputation Rates in Patients Taking Clopidogrel After Endovascular Intervention for Critical Limb Ischaemia

“…3,8,9 Few studies have addressed the issue of platelet function tests in LEAD, and none of them reported that platelet function after clopidogrel use was associated with the clinical outcomes. 26,27 In the present study, it was found that platelet function test variability was significant in univariable but not multivariable Cox analysis. By contrast, the effects of CYP2C19 polymorphisms remained prominent even in the multivariable Cox analysis, which may have diminished the effects of the platelet function test.…”

Impact of high on-treatment platelet reactivity after angioplasty in patients with critical limb ischemia

“…Association of platelet function measured by platelet function assays and clinical events is controversial. However, several studies showed an association between MACCE and HTPR in PAD patients [29,38]. However, CLI patients were not investigated separately.…”