Safety and efficacy of ticagrelor versus clopidogrel for carotid artery stenting: propensity score matched analysis
Jay Kakadiya1, Huanwen Chen2, Arsh Patankar3
1Division of Neuroradiology, Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA.
Journal of Neurointerventional Surgery
|January 13, 2026
Insights
Ticagrelor and clopidogrel show similar safety and effectiveness for patients undergoing carotid artery stenting (CAS). Further research is needed to confirm these findings in genotype-informed trials.
Area of Science:
- Cardiovascular Medicine
- Interventional Cardiology
- Pharmacology
Background:
- Dual antiplatelet therapy (DAPT) is standard post-carotid artery stenting (CAS) to prevent stroke.
- Clopidogrel's efficacy is limited by patient-specific factors like CYP2C19 genetics.
- Ticagrelor offers a potent alternative, but its comparative role in CAS is unclear.
Purpose of the Study:
- To compare the safety and effectiveness of ticagrelor versus clopidogrel in patients undergoing CAS.
- To evaluate outcomes including ischemic stroke, hemorrhage, and mortality at 180 days.
Main Methods:
- Retrospective cohort study using the TriNetX database (January 2016 - August 2025).
- Included adults with carotid artery stenosis undergoing CAS, treated with either ticagrelor or clopidogrel.
- Propensity score matching (1:1) and survival analyses were employed.
Main Results:
- After matching 377 patients per group, ticagrelor showed numerically lower rates of ischemic stroke and major hemorrhage.
- Intracranial hemorrhage and all-cause mortality rates were similar between groups.
- Ticagrelor was associated with numerically lower inpatient readmissions, while ED visits were comparable.
Conclusions:
- Ticagrelor and clopidogrel demonstrate comparable safety and effectiveness in the post-CAS setting.
- Prospective, genotype-guided trials are recommended to validate these findings.
Abstract
No abstract available in PubMed .
