Background
Carotid artery stenting (CAS) is minimally invasive but may cause perioperative cerebral
infarction associated with distal embolization. We conducted a multicenter prospective
observational study on the onset of vascular events after CAS to find out the efficacy
and safety of CAS in Japan and to investigate the effects of antiplatelet drugs administered
before and after CAS on efficacy and safety of CAS.
Methods
A total of 949 patients with cervical carotid artery stenosis were enrolled at 43
institutions in Japan; 934 who had undergone CAS with antiplatelet drugs and followed
for 1 year were analyzed. Primary end point was the incidence of the first event of
death, ischemic stroke, hemorrhagic stroke, transient ischemic attack, myocardial
infarction, or serious hemorrhage within 1 year after enrollment. Comparison of the
incidences of events according to antiplatelet drugs was also conducted.
Results
The primary end point was observed in 69 patients (7.4%) within 30 days of enrollment
and in 40 patients (4.3%) between 31 days and 1 year after enrollment. The incidence
of the first event for aspirin + cilostazol was significantly lower than that for
aspirin + clopidogrel (P = .01), aspirin + clopidogrel + cilostazol (P = .01), and antiplatelet monotherapy (P < .01). Patient age (P = .01), presence of ischemic cerebrovascular disease (P = .02), presence of antidiabetic drugs (P < .01), femoral artery puncture (P = .02), guiding catheter used (P = .02), and Angioguard XP used (P = .01) were also correlated with the primary end point.
Conclusion
Incidences of the primary end point within 30 days and 1 year of enrollment were comparable
with previous reports, suggesting that CAS is a useful alternative for carotid endarterectomy
in carotid stenosis patients with high risk for carotid endarterectomy. Further randomized
controlled studies are needed to determine whether differences in mechanism of action
of antiplatelet drugs might have contributed to the results of the present study.
Key Words
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Article info
Publication history
Published online: February 19, 2014
Accepted:
November 20,
2013
Received in revised form:
October 22,
2013
Received:
May 8,
2013
Footnotes
Grant support: This study was supported by Sanofi-aventis Co. Ltd.
Identification
DOI: https://doi.org/10.1016/j.jstrokecerebrovasdis.2013.11.018
Copyright
© 2014 National Stroke Association. Published by Elsevier Inc. All rights reserved.
