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Published on: May 14, 2013

Carotid artery stenting outcomes: do they correlate with antiplatelet response assays?

Grant C Sorkin1, Travis M Dumont, Michael M Wach

  • 1Department of Neurosurgery, University at Buffalo, State University of New York, Buffalo, New York, USA.

Journal of Neurointerventional Surgery
|June 25, 2013
PubMed

Insights

Higher P2Y12 reaction units (PRU) after carotid artery stenting (CAS) correlate with increased stroke risk. A PRU of 198 or less may improve outcomes, but further research is needed.

Area of Science:

  • Neuroendovascular Intervention
  • Cardiovascular Research
  • Clinical Trials

Background:

  • Limited data exist on antiplatelet response assays in neuroendovascular procedures.
  • Carotid artery stenting (CAS) requires effective antiplatelet therapy to prevent ischemic events.

Purpose of the Study:

  • To evaluate the association between aspirin and P2Y12 assay results and clinical outcomes following CAS.
  • To determine optimal thresholds for P2Y12 reaction units (PRU) to predict post-CAS complications.

Main Methods:

  • Retrospective analysis of 449 patients undergoing CAS with pre-intervention antiplatelet therapy.
  • Aspirin and P2Y12 assays performed on postoperative day 0/1.
  • Outcomes assessed included neurological ischemic sequelae, death, hemorrhage, and myocardial infarction at 30 days, 1 year, and 2 years.

Main Results:

  • Higher mean PRU values were observed in patients experiencing ischemic events (stroke/TIA) or stroke at 1 and 2 years post-CAS.
  • Patients with PRU ≤198 demonstrated longer ischemic event-free survival and overall survival compared to those with PRU ≤237.
  • Higher mean PRU values were associated with 30-day all-cause mortality; no correlation was found between lower PRU and hemorrhage.
  • Aspirin reaction units did not correlate with clinical outcomes.

Conclusions:

  • A P2Y12 reaction unit (PRU) threshold of ≤198 may be associated with reduced ischemic neurological sequelae and mortality post-CAS.
  • Prospective studies are necessary to confirm the relationship between antiplatelet assay monitoring and outcomes in patients undergoing CAS.
Abstract

Keywords:
DrugPlateletsStentStrokeTechnique

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