Kouhei Nii1, Yusuke Takemura2, Ritsurou Inoue2, Yusuke Morinaga2, Takafumi Mitsutake2, Toshio Higashi3. 1. Department of Neurosurgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan; Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Nanakuma, Jonan-ku, Fukuoka, Japan. Electronic address: k.nii@cis.fukuoka-u.ac.jp. 2. Department of Neurosurgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan. 3. Department of Neurosurgery, Fukuoka University Chikushi Hospital, 1-1-1 Zokumyoin, Chikushino, Fukuoka 818-8502, Japan; Stroke Prevention and Community Healthcare, Fukuoka University Graduate School, Nanakuma, Jonan-ku, Fukuoka, Japan.
Abstract
BACKGROUND: The periprocedural administration of dual antiplatelet therapy has been recommended in patients treated by carotid artery stenting. However, some patients with concurrent disease have been prescribed anticoagulants. We compared the post-operative incidence of hemorrhagic and thromboembolic events in two patient groups treated by different regimens of multi-antithrombotic agents. METHODS: As our 31 patients had a history of nonvalvular atrial fibrillation, they had received anticoagulants; they were also treated with aspirin and clopidogrel before carotid artery stenting. The prior anticoagulant therapy was continued in 17 patients and they received vitamin K antagonist plus dual antiplatelet therapy after the procedure (group 1). Other 14 patients underwent direct oral anticoagulant plus aspirin or clopidogrel (group 2). Post-procedural hemorrhagic and thromboembolic events were compared between two groups. RESULTS: Carotid artery stenting was angiographically successful in all patients. Complications were encountered in two group 1 patients. Post-operative image revealed a silent subarachnoid hemorrhage in one. The other presented with superior mesenteric artery occlusion 6 months after the procedure. No hemorrhagic or thromboembolic events occurred in group 2. CONCLUSION: We concluded that the administration of a direct oral anticoagulant plus an antiplatelet agent reduced the risk for periprocedural hemorrhagic and embolic events in patients with concurrent nonvalvular atrial fibrillation who underwent carotid artery stenting.
BACKGROUND: The periprocedural administration of dual antiplatelet therapy has been recommended in patients treated by carotid artery stenting. However, some patients with concurrent disease have been prescribed anticoagulants. We compared the post-operative incidence of hemorrhagic and thromboembolic events in two patient groups treated by different regimens of multi-antithrombotic agents. METHODS: As our 31 patients had a history of nonvalvular atrial fibrillation, they had received anticoagulants; they were also treated with aspirin and clopidogrel before carotid artery stenting. The prior anticoagulant therapy was continued in 17 patients and they received vitamin K antagonist plus dual antiplatelet therapy after the procedure (group 1). Other 14 patients underwent direct oral anticoagulant plus aspirin or clopidogrel (group 2). Post-procedural hemorrhagic and thromboembolic events were compared between two groups. RESULTS: Carotid artery stenting was angiographically successful in all patients. Complications were encountered in two group 1 patients. Post-operative image revealed a silent subarachnoid hemorrhage in one. The other presented with superior mesenteric artery occlusion 6 months after the procedure. No hemorrhagic or thromboembolic events occurred in group 2. CONCLUSION: We concluded that the administration of a direct oral anticoagulant plus an antiplatelet agent reduced the risk for periprocedural hemorrhagic and embolic events in patients with concurrent nonvalvular atrial fibrillation who underwent carotid artery stenting.
Authors: B Pardo-Galiana; M Medina-Rodriguez; M Millan-Vazquez; J A Cabezas-Rodriguez; L Lebrato-Hernandez; L Ainz-Gomez; E Zapata-Arriaza; J Ortega; A de Albóniga-Chindurza; J Montaner; A Gonzalez; F Moniche Journal: AJNR Am J Neuroradiol Date: 2022-04-07 Impact factor: 3.825
Authors: Johannes M Weller; Franziska Dorn; Julius N Meissner; Sebastian Stösser; Niklas M Beckonert; Julia Nordsiek; Christine Kindler; Christoph Riegler; Fee Keil; Gabor C Petzold; Felix J Bode Journal: Neurol Res Pract Date: 2022-09-12