Single Versus Double Antiplatelet Therapy in Patients Undergoing Endovascular Treatment With a Stent for an Iliac
Taira Kobayashi1, Takanobu Okazaki1, Ryo Okusako1
1Department of Cardiovascular Surgery, JA Hiroshima General Hospital, Hiroshima, Japan.
Insights
Single antiplatelet therapy (SAPT) after iliac endovascular treatment (EVT) offers similar restenosis and target lesion revascularization rates compared to double antiplatelet therapy (DAPT). This finding suggests SAPT may be a viable option post-iliac EVT.
Area of Science:
- Vascular Surgery
- Interventional Cardiology
- Pharmacology
Background:
- Endovascular treatment (EVT) is a primary therapy for aorto-iliac occlusive lesions.
- The optimal antiplatelet regimen (single vs. double) post-iliac EVT remains debated.
Purpose of the Study:
- To compare clinical outcomes of single antiplatelet therapy (SAPT) versus double antiplatelet therapy (DAPT) after iliac EVT.
- To assess restenosis and target lesion revascularization (TLR) rates using propensity score matching.
Main Methods:
- Retrospective analysis of 150 patients undergoing iliac EVT from 2017-2023.
- Propensity score matching to compare SAPT and DAPT groups.
- Primary endpoints: freedom from restenosis and freedom from TLR.
Main Results:
- No significant difference in 5-year freedom from restenosis (92% vs. 90%, P=.80) or TLR (P=.80) between SAPT and DAPT groups after matching.
- Technical success, access site complications, and compression time were similar.
- A trend towards lower major bleeding in the SAPT group (7% vs. 18% at 5 years, P=.10).
Conclusions:
- SAPT after iliac EVT demonstrates comparable efficacy to DAPT regarding restenosis and TLR.
- SAPT may be a suitable alternative to DAPT, potentially with a better safety profile regarding bleeding.
Abstract:
ObjectiveEndovascular treatment (EVT) for an aorto-iliac occlusive lesion is performed worldwide as first-line treatment. However, the choice of single antiplatelet therapy (SAPT) or double antiplatelet therapy (DAPT) after aorto-iliac revascularization is controversial. The purpose of the study was to assess clinical outcomes in patients with SAPT or DAPT after iliac EVT, using propensity score matching.MethodPatients who underwent EVT for a de-novo iliac occlusive lesion at a single center from 2017 to 2023 were analyzed retrospectively. Comparisons were made between SAPT and DAPT cases after propensity score matching. The primary endpoints of the study were freedom from restenosis and freedom from target lesion revascularization (TLR).ResultsA total of 150 patients underwent iliac EVT and received SAPT (n = 93) or DAPT (n = 57). The DAPT group had a significantly higher rate of coronary artery disease (P = .010). After matching, the differences in baseline and procedural details were diminished. The technical success rate of EVT, access site complications, and manual compression time did not differ between the groups. The median follow-up period was 33 (20-47) months. During follow-up, restenosis occurred in 11 cases (7%) and 10 cases (7%) underwent TLR. After matching, the 5-year freedom from restenosis did not differ significantly in the SAPT and DAPT groups (92% vs 90%, P = .80). Freedom from TLR also did not differ between the groups (P = .80). There was a tendency for a lower incident rate of major bleeding in the SAPT group (7% vs 18% at 5 years, P = .10).ConclusionsRetrospective analysis using propensity score matching showed that SAPT after iliac EVT resulted in similar freedom from restenosis and TLR compared with DAPT.
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