The Influence of Anti-Platelet Resistance on the Development of Cerebral Ischemic Lesion after Carotid Artery Stenting.
10.3349/ymj.2013.54.2.288
- Author:
Tae Jin SONG
1
;
Sang Hyun SUH
;
Pil Ki MIN
;
Dong Joon KIM
;
Byung Moon KIM
;
Ji Hoe HEO
;
Young Dae KIM
;
Kyung Yul LEE
Author Information
1. Department of Neurology, Yonsei University College of Medicine, Seoul, Korea. kylee@yuhs.ac
- Publication Type:Original Article ; Research Support, Non-U.S. Gov't
- Keywords:
Cerebral infarction;
aspirin resistance;
clopidogrel resistance;
carotid artery stent
- MeSH:
Aged;
Aspirin/*therapeutic use;
Brain Ischemia/diagnosis/*etiology;
Carotid Arteries/*surgery;
*Drug Resistance;
Female;
Humans;
Male;
Middle Aged;
Multivariate Analysis;
Platelet Aggregation Inhibitors/*therapeutic use;
Retrospective Studies;
Stents/*adverse effects
- From:Yonsei Medical Journal
2013;54(2):288-294
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Cerebral ischemic lesions are frequently observed after carotid artery stenting (CAS), and anti-platelet agents are used to prevent stent thrombosis and peri-procedural complications. However, despite the premedication, cerebral ischemic lesions are observed, suggesting that they may rather be related to anti-platelet resistance. We, therefore, investigated the effects of anti-platelet resistance on the development of cerebral ischemic lesions after CAS. MATERIALS AND METHODS: We retrospectively reviewed patients who received CAS and selected patients for whom brain MRI was performed within 24 hours after CAS and for whom anti-platelet resistance was checked. Anti-platelet resistance was examined by the VerifyNow system. We analyzed the correlation between anti-platelet resistance and cerebral ischemic lesions detected on follow-up MRI. RESULTS: Among 76 patients, 45 (59.2%) developed new ischemic lesions after CAS. Twelve (15.8%) patients showed aspirin resistance and 50 (65.8%) patients showed clopidogrel resistance. Patients with a new ischemic lesion demonstrated a significantly greater frequency of clopidogrel resistance than those who had no new ischemic lesion (82.2% versus 41.9%, p=0.001). The frequency of aspirin resistance was not significantly different between the groups of patients with and without new ischemic lesions (20.0% versus 9.7%, p=0.340). In multivariate analysis, clopidogrel resistance was a significant risk factor for post-procedural cerebral ischemia. CONCLUSION: Anti-platelet resistance can be used to predict new ischemic lesions after CAS. Anti-platelet resistance should be evaluated in all patients prior to CAS to prevent ischemic complications related to CAS.
