The Utility of Antiplatelet Assay-Guided Individualized Dual Antiplatelet Therapy in Carotid Artery Stenting for...

To evaluate the efficacy of individualized dual antiplatelet therapy (DAPT) using VerifyNow in reducing periprocedural ischemic complications following carotid artery stenting (CAS), particularly in patients with unstable plaques.

This retrospective, single-center study included 187 patients who underwent elective CAS between January 2018 and September 2024. Patients were divided into two groups : a conventional DAPT (c-DAPT) group treated with aspirin and clopidogrel (n=89), and an individualized DAPT (i-DAPT) group (n=98) where antiplatelet regimens were adjusted based on preoperative platelet reactivity measured by VerifyNow. The primary outcome was the incidence of ischemic lesions on diffusion-weighted imaging (DWI) following CAS. Risk factors and the impact of DAPT personalization on ischemic changes were analyzed using multivariate logistic regression.

DWI-positive ischemic lesions were observed in 62.9% of the c-DAPT group and 51% of the i-DAPT group (p=0.07). Although the difference was not statistically significant, there was a trend toward reduced ischemic changes with individualized therapy. Multivariate analysis identified hypertension, diabetes mellitus, and unstable plaque as independent predictors of post-CAS ischemic changes. Subgroup analysis showed that VerifyNow-guided i-DAPT significantly reduced ischemic events in patients with unstable plaques (odds ratio, 0.49; p=0.03), whereas no significant effect was observed in other subgroups.

VerifyNow-guided personalization of antiplatelet therapy is a safe and may have the potential to reduce periprocedural ischemic complications in CAS, particularly in patients with unstable plaques. Further multicenter prospective studies are needed to validate these findings and optimize individualized antiplatelet regimens.