Secondary Prevention after Carotid Stenting in Patients With Atrial Fibrillation

Area of Science:

• Cardiology
• Neurology
• Vascular Surgery

Background:

• Optimal secondary stroke prevention after carotid artery stenting (CAS) in atrial fibrillation patients lacks consensus.
• Existing treatment strategies involve various combinations of antiplatelet and anticoagulant therapies.
• Understanding the comparative efficacy and safety of these regimens is crucial for clinical decision-making.

Purpose of the Study:

• To compare the long-term efficacy and safety of different medical regimens following CAS in patients with atrial fibrillation.
• To evaluate outcomes including major bleeding, minor bleeding, recurrent stroke, and stent thrombosis.

Main Methods:

• Retrospective observational study including 129 patients with atrial fibrillation undergoing CAS between 2011 and 2024.
• Patients were categorized into three groups: dual antiplatelet therapy (DAPT), single antiplatelet therapy plus oral anticoagulation (AA), and triple therapy (TT).
• Primary outcome was major bleeding; secondary outcomes included minor bleeding, recurrent stroke, and stent thrombosis.

Main Results:

• No significant differences in major bleeding events at 3 months were observed across the DAPT (3.2%), AA (6.5%), and TT (7.7%) groups (P = 0.71).
• Incidence of ischemic stroke post-stent placement was similar: DAPT (6.4%), AA (4.3%), and TT (1.9%) (P = 0.57).
• Stent thrombosis rates also showed no significant variation: DAPT (3.2%), AA (6.5%), and TT (1.9%) (P = 0.32).

Conclusions:

• Findings suggest comparable long-term safety and efficacy among DAPT, AA, and TT regimens for secondary stroke prevention in atrial fibrillation patients post-CAS.
• Further prospective studies are warranted to confirm these observations and refine treatment guidelines.