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Published on: May 14, 2013
Carotid Restenosis Following Endarterectomy in Patients Managed With Single Antiplatelet Therapy Versus Dual
Owen S Glotzer1, Elianne Rojas2, David Roberge Bouchard3
1Division of Vascular Surgery, 5973Albany Medical Center Hospital, Albany Medical College, Albany, NY, USA.
Insights
Dual antiplatelet therapy (DAPT) after carotid endarterectomy (CEA) showed lower rates of late restenosis compared to single antiplatelet therapy (SAPT). However, no significant difference in reintervention rates was observed between the groups.
Area of Science:
- Vascular Surgery
- Cardiology
- Clinical Outcomes Research
Background:
- Antiplatelet therapy is crucial after carotid endarterectomy (CEA).
- Limited data exists on dual antiplatelet therapy (DAPT) versus single antiplatelet therapy (SAPT) for restenosis post-CEA.
Purpose of the Study:
- To compare restenosis rates between DAPT and SAPT following CEA.
- To evaluate the impact of DAPT on postoperative complications and reintervention needs.
Main Methods:
- Retrospective review of 1453 patients undergoing CEA (2007-2013).
- Comparison of restenosis rates, severity, timing, complications, and reinterventions between DAPT and SAPT groups.
- Carotid duplex used for restenosis evaluation.
Main Results:
- No significant difference in early restenosis (<2 years) between DAPT and SAPT groups.
- Significantly lower rates of late restenosis (>2 years) in the DAPT group (16.1%) compared to SAPT group (29.9%).
- Multivariable and propensity-matched analyses confirmed lower late restenosis risk with DAPT (adjusted OR 0.48 and 0.35, respectively).
- No difference in reintervention rates between DAPT (3.8%) and SAPT (3.3%) groups.
Conclusions:
- DAPT is associated with reduced late restenosis rates after CEA.
- Despite lower restenosis, DAPT did not lead to a significant difference in reintervention rates during the study period.
Background:
Antiplatelet therapy is a cornerstone in the management of carotid artery disease following carotid endarterectomy (CEA). There is a paucity of data regarding the effect of dual antiplatelet therapy (DAPT) on restenosis rates.
Methods:
A retrospective review of patients who underwent CEA from January 1, 2007 to December 31, 2013 was performed at a single center. Study groups consisted of subjects who received DAPT and those who received single antiplatelet therapy (SAPT) following CEA. Restenosis was evaluated by carotid duplex. Severity and timing of restenosis, postoperative complications, and reinterventions were compared between study groups.
Results:
Between January 1, 2007 and December 31, 2013, 1453 patients underwent CEA. The SAPT group consisted of 245 patients and the DAPT group consisted of 1208 patients. No difference in restenosis was identified between groups at less than 6 weeks (6.5% vs. 11.7% 50-79% stenosis, 0% vs. 2.2% 80-99% stenosis, 2.2% vs. 0.6% occlusion, p = 0.368), and 6 weeks to 2 years (20.6% vs. 17.9% 50-79% stenosis, 1.1% vs. 1.0% 80-99% stenosis, 1.6% vs. 0.4% occlusion, p = 0.242). A higher rate of restenosis in SAPT was found greater than 2 years from surgery (68.4% vs. 82.4% <50% stenosis, 29.9% vs. 16.1% 50-79% stenosis, 0% vs. 0.6% 80-99% stenosis, 1.7% vs. 0.9% occlusion p = 0.004). This finding persisted on multivariable analysis with 31.6% of the SAPT group showing >50% stenosis vs. 17.6% of the DAPT group (adjusted OR 0.48, 95% CI 0.30-0.76, p = 0.002). In a propensity matched-population, 32.7% of the SAPT group demonstrated restenosis vs. 13.7% of the DAPT group (adjusted OR 0.35, 95% CI 0.16-0.77, p = 0.009). There was no difference in the need for reintervention between study groups (DAPT 3.8% vs SAPT 3.3%, p = 0.684).
Conclusion:
Following CEA, patients on DAPT exhibited lower rates of late restenosis. Despite this finding, a clinical difference in reintervention was not found during this study period.
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