Carotid artery stenting outcomes: do they correlate with antiplatelet response assays?
Carotid artery stenting outcomes: do they correlate with antiplatelet response assays?
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DOI：
10.1136/neurintsurg-2013-010771
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发表时间：
2014-06-01
影响因子：
4.8
通讯作者：
Siddiqui, Adnan H.
中科院分区：
文献类型：
--
作者：
Sorkin, Grant C.;Dumont, Travis M.;Siddiqui, Adnan H.
目的：神经血管内介入治疗中抗血小板反应试验的使用数据有限。我们报告的结果后，颈动脉支架（CAS）的基础上阿司匹林和P2 Y12 assays.Methods，我们回顾性地确定了患者阿司匹林和P2 Y12分析在支架植入术的时间。在干预前7- 10天开始服用阿司匹林（325 mg）和氯吡格雷（75 mg）。如果不可能，则在干预前给予阿司匹林（650 mg）和氯吡格雷（600 mg）负荷剂量。在术后第0/1天检查分析。结果共纳入449例患者，随访30天、1年、2年，观察神经系统缺血后遗症及30天死亡、出血、心肌梗死等情况。发生同侧缺血事件的患者的平均P2 Y12反应单位（PRU）值较高与无事件患者相比，1年和2年时发生脑卒中（卒中/短暂性脑缺血发作（TIA））或卒中（单独）的患者：1年时发生缺血性事件vs无事件，252 vs 202（p=0.008）; 1年时卒中与无卒中，252例与203例（p=0.029）; 2年时缺血性事件与无事件，244例与203例（p=0.047）; 2年时卒中与无卒中，243例与203例（p=0.082）。与PRU 237的初始阈值相比，PRU 198的患者CAS后的无缺血事件生存期（卒中/TIA，p= 0.0268）和总生存期（p=0.0291）更长。在30天时死于所有原因的患者的平均PRU值高于存活者（p=0.031）。PRU值降低与出血之间无相关性。结论PRU 198可能与CAS术后缺血性神经系统后遗症和死亡的发生率较低有关。需要前瞻性研究来验证抗血小板测定与CAS后结局之间的关系。
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 (325mg) and clopidogrel (75mg) were started 7-10days pre-intervention. If not possible, aspirin (650mg) and clopidogrel (600mg) loading doses were given pre-intervention. Assays were checked on postoperative day 0/1. Outcomes included neurological ischemic sequela at 30days, 1 and 2years, 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 2years than in patients with no events: ischemic event versus no event at 1year, 252 vs 202 (p=0.008); stroke versus no stroke at 1year, 252 versus 203(p=0.029); ischemic event versus no event at 2years, 244 vs 203 (p=0.047); stroke versus no stroke at 2years, 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 30days 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.