Carotid artery stenting outcomes: Do they correlate with antiplatelet response assays?

Grant C. Sorkin, Travis M Dumont, Michael M. Wach, Jorge L. Eller, Maxim Mokin, Sabareesh K. Natarajan, Melissa S. Baxter, Kenneth V. Snyder, Elad I. Levy, L. Nelson Hopkins, Adnan H. Siddiqui

Research output: Contribution to journalArticle

8 Citations (Scopus)

Abstract

Objective: Limited data exist regarding the use of antiplatelet response assays during neuroendovascular intervention. We report outcomes after carotid artery stenting (CAS) based on aspirin and P2Y12 assays. Methods: We retrospectively identified patients who had aspirin and P2Y12 assays at the time of stenting. Aspirin (325 mg) and clopidogrel (75 mg) were started 7-10 days pre-intervention. If not possible, aspirin (650 mg) and clopidogrel (600 mg) loading doses were given pre-intervention. Assays were checked on postoperative day 0/1. Outcomes included neurological ischemic sequela at 30 days, 1 and 2 years, as well as 30 day death/hemorrhage/myocardial infarction. Results: 449 patients were included. Mean P2Y12 reaction unit (PRU) values were higher in patients with an ipsilateral ischemic event (stroke/transient ischemic attack (TIA)) or stroke (alone) at 1 and 2 years than in patients with no events: ischemic event versus no event at 1 year, 252 vs 202 (p=0.008); stroke versus no stroke at 1 year, 252 versus 203(p=0.029); ischemic event versus no event at 2 years, 244 vs 203 (p=0.047); stroke versus no stroke at 2 years, 243 versus 203 (p=0.082). Ischemic event free survival (stroke/TIA, p=0.0268) and overall survival (p=0.0291) post-CAS were longer in patients with PRU ≤198 compared with an initial threshold of PRU ≤237. Mean PRU values were higher in patients who died from all causes at 30 days than in survivors (p=0.031). No correlation was found between lower PRU values and hemorrhage. Aspirin reaction units did not correlate with outcome. Conclusions: PRU ≤198 may be associated with a lower incidence of ischemic neurological sequela and death post-CAS. Prospective studies are needed to validate the relationship between antiplatelet assays and outcomes post-CAS.

Original languageEnglish (US)
Pages (from-to)373-378
Number of pages6
JournalJournal of NeuroInterventional Surgery
Volume6
Issue number5
DOIs
StatePublished - 2014
Externally publishedYes

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Carotid Arteries
Stroke
Aspirin
clopidogrel
Transient Ischemic Attack
Hemorrhage
Disease-Free Survival
Survivors
Myocardial Infarction
Prospective Studies
Survival
Incidence

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Medicine(all)

Cite this

Carotid artery stenting outcomes : Do they correlate with antiplatelet response assays? / Sorkin, Grant C.; Dumont, Travis M; Wach, Michael M.; Eller, Jorge L.; Mokin, Maxim; Natarajan, Sabareesh K.; Baxter, Melissa S.; Snyder, Kenneth V.; Levy, Elad I.; Hopkins, L. Nelson; Siddiqui, Adnan H.

In: Journal of NeuroInterventional Surgery, Vol. 6, No. 5, 2014, p. 373-378.

Research output: Contribution to journalArticle

Sorkin, GC, Dumont, TM, Wach, MM, Eller, JL, Mokin, M, Natarajan, SK, Baxter, MS, Snyder, KV, Levy, EI, Hopkins, LN & Siddiqui, AH 2014, 'Carotid artery stenting outcomes: Do they correlate with antiplatelet response assays?', Journal of NeuroInterventional Surgery, vol. 6, no. 5, pp. 373-378. https://doi.org/10.1136/neurintsurg-2013-010771
Sorkin, Grant C. ; Dumont, Travis M ; Wach, Michael M. ; Eller, Jorge L. ; Mokin, Maxim ; Natarajan, Sabareesh K. ; Baxter, Melissa S. ; Snyder, Kenneth V. ; Levy, Elad I. ; Hopkins, L. Nelson ; Siddiqui, Adnan H. / Carotid artery stenting outcomes : Do they correlate with antiplatelet response assays?. In: Journal of NeuroInterventional Surgery. 2014 ; Vol. 6, No. 5. pp. 373-378.
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abstract = "Objective: Limited data exist regarding the use of antiplatelet response assays during neuroendovascular intervention. We report outcomes after carotid artery stenting (CAS) based on aspirin and P2Y12 assays. Methods: We retrospectively identified patients who had aspirin and P2Y12 assays at the time of stenting. Aspirin (325 mg) and clopidogrel (75 mg) were started 7-10 days pre-intervention. If not possible, aspirin (650 mg) and clopidogrel (600 mg) loading doses were given pre-intervention. Assays were checked on postoperative day 0/1. Outcomes included neurological ischemic sequela at 30 days, 1 and 2 years, as well as 30 day death/hemorrhage/myocardial infarction. Results: 449 patients were included. Mean P2Y12 reaction unit (PRU) values were higher in patients with an ipsilateral ischemic event (stroke/transient ischemic attack (TIA)) or stroke (alone) at 1 and 2 years than in patients with no events: ischemic event versus no event at 1 year, 252 vs 202 (p=0.008); stroke versus no stroke at 1 year, 252 versus 203(p=0.029); ischemic event versus no event at 2 years, 244 vs 203 (p=0.047); stroke versus no stroke at 2 years, 243 versus 203 (p=0.082). Ischemic event free survival (stroke/TIA, p=0.0268) and overall survival (p=0.0291) post-CAS were longer in patients with PRU ≤198 compared with an initial threshold of PRU ≤237. Mean PRU values were higher in patients who died from all causes at 30 days than in survivors (p=0.031). No correlation was found between lower PRU values and hemorrhage. Aspirin reaction units did not correlate with outcome. Conclusions: PRU ≤198 may be associated with a lower incidence of ischemic neurological sequela and death post-CAS. Prospective studies are needed to validate the relationship between antiplatelet assays and outcomes post-CAS.",
author = "Sorkin, {Grant C.} and Dumont, {Travis M} and Wach, {Michael M.} and Eller, {Jorge L.} and Maxim Mokin and Natarajan, {Sabareesh K.} and Baxter, {Melissa S.} and Snyder, {Kenneth V.} and Levy, {Elad I.} and Hopkins, {L. Nelson} and Siddiqui, {Adnan H.}",
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T1 - Carotid artery stenting outcomes

T2 - Do they correlate with antiplatelet response assays?

AU - Sorkin, Grant C.

AU - Dumont, Travis M

AU - Wach, Michael M.

AU - Eller, Jorge L.

AU - Mokin, Maxim

AU - Natarajan, Sabareesh K.

AU - Baxter, Melissa S.

AU - Snyder, Kenneth V.

AU - Levy, Elad I.

AU - Hopkins, L. Nelson

AU - Siddiqui, Adnan H.

PY - 2014

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N2 - Objective: Limited data exist regarding the use of antiplatelet response assays during neuroendovascular intervention. We report outcomes after carotid artery stenting (CAS) based on aspirin and P2Y12 assays. Methods: We retrospectively identified patients who had aspirin and P2Y12 assays at the time of stenting. Aspirin (325 mg) and clopidogrel (75 mg) were started 7-10 days pre-intervention. If not possible, aspirin (650 mg) and clopidogrel (600 mg) loading doses were given pre-intervention. Assays were checked on postoperative day 0/1. Outcomes included neurological ischemic sequela at 30 days, 1 and 2 years, as well as 30 day death/hemorrhage/myocardial infarction. Results: 449 patients were included. Mean P2Y12 reaction unit (PRU) values were higher in patients with an ipsilateral ischemic event (stroke/transient ischemic attack (TIA)) or stroke (alone) at 1 and 2 years than in patients with no events: ischemic event versus no event at 1 year, 252 vs 202 (p=0.008); stroke versus no stroke at 1 year, 252 versus 203(p=0.029); ischemic event versus no event at 2 years, 244 vs 203 (p=0.047); stroke versus no stroke at 2 years, 243 versus 203 (p=0.082). Ischemic event free survival (stroke/TIA, p=0.0268) and overall survival (p=0.0291) post-CAS were longer in patients with PRU ≤198 compared with an initial threshold of PRU ≤237. Mean PRU values were higher in patients who died from all causes at 30 days than in survivors (p=0.031). No correlation was found between lower PRU values and hemorrhage. Aspirin reaction units did not correlate with outcome. Conclusions: PRU ≤198 may be associated with a lower incidence of ischemic neurological sequela and death post-CAS. Prospective studies are needed to validate the relationship between antiplatelet assays and outcomes post-CAS.

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