Evaluating the optimal activated clotting time during carotid artery stenting

Area of Science:

• Cardiovascular medicine
• Interventional cardiology
• Vascular surgery

Background:

• Carotid artery stenting (CAS) is a viable alternative to carotid endarterectomy for patients with severe carotid artery stenosis who are at high surgical risk.
• Unfractionated heparin is commonly used during CAS, but optimal anticoagulation targets remain undefined.
• Limited data exist on the ideal activated clotting time (ACT) during CAS procedures.

Purpose of the Study:

• To determine the optimal peak activated clotting time (ACT) during carotid artery stenting (CAS) associated with the lowest incidence of adverse cardiovascular events.
• To evaluate the relationship between ACT levels and the combined endpoint of death, stroke, or myocardial infarction following CAS.

Main Methods:

• Retrospective analysis of 605 patients who underwent carotid artery stenting.
• Patients received unfractionated heparin for anticoagulation during the procedure.
• Activated clotting time (ACT) was monitored, and peak procedural ACT values were analyzed in relation to clinical outcomes.

Main Results:

• The optimal peak procedural activated clotting time (ACT) for carotid artery stenting was identified as 250 to 299 seconds.
• This ACT range was associated with the lowest combined incidence of death, stroke, or myocardial infarction.
• Other ACT ranges showed a higher combined incidence of these adverse events.

Conclusions:

• A peak procedural activated clotting time (ACT) between 250 and 299 seconds is recommended during carotid artery stenting with unfractionated heparin.
• Achieving this ACT range may help minimize the risk of peri-procedural death, stroke, and myocardial infarction in high-risk patients undergoing CAS.