Safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis in patients with vertebral artery stenosis
10.3760/cma.j.issn.1673-4165.2019.10.002
- VernacularTitle: 阿加曲班在椎动脉狭窄患者支架置入术中的安全性及对再狭窄的影响
- Author:
Mingyue ZHU
1
,
2
;
Lulu XIAO
1
;
Dezhi LIU
1
,
3
;
Xiaohao ZHANG
1
,
4
;
Qiushi LYU
1
;
Xinfeng LIU
1
Author Information
1. Department of Neurology, Jinling Hospital, Nanjing 210002, China
2. Department of Neurology, Nanjing Hospital of TCM, Nanjing 210012, China
3. Department of Neurology, Shanghai General Hospital, Shanghai 200080, China
4. Department of Neurology, the Second Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing 210017, China
- Publication Type:Clinical Trail
- Keywords:
Vertebrobasilar insufficiency;
Vertebral artery;
Stents;
Antithrombins;
Heparin;
Risk factors;
Treatment outcome;
Argatroban
- From:
International Journal of Cerebrovascular Diseases
2019;27(10):725-730
- CountryChina
- Language:Chinese
-
Abstract:
Objective:To investigate the safety of argatroban in vertebral artery stenting and its effect on postoperative restenosis.
Methods:From January 2013 to September 2017, patients undergoing vertebral artery stenting in the Department of Neurology, Jinling Hospital were enrolled prospectively. They were divided into agatraban group and heparin group by random number table method. The argatroban group received argatroban anticoagulation during the procedure, and was continuously used for 5 d after procedure; while the heparin group underwent heparin anticoagulation during the procedure, and used saline as placebo after procedure. Clinical follow-up was performed at 1, 3, and 6 months after procedure. Digital subtraction angiography, CT angiography, or magnetic resonance angiography were performed at 6 months to evaluate the restenosis of the treated blood vessels. The primary endpoints included intraoperative safety, in-stent restenosis after procedure, and any clinical events that occurred during the follow-up period, including stroke, cardiovascular events, and death. Major safety events included bleeding from various organs, allergic reactions, liver dysfunction, and embolism events. Kaplan-Meier survival curve was used to evaluate the incidence of vascular events during the follow-up period.
Results:A total of 105 patients were enrolled in the analysis, including 53 in the argatroban group and 52 in the heparin group. During the periprocedural period, no hemorrhagic events, allergic reactions, liver dysfunction or embolism events occurred in both groups. There were no significant differences in preoperative vertebral artery stenosis degree, postoperative residual stenosis degree, and stenosis degree at 6 months after procedure between the two groups, but the increase of stent stenosis at 6 months after procedure in the agatroban group was significantly lower than that in the heparin group (13.56%±26.41% vs. 4.25%±15.76%; P=0.031). There was no significant difference in the incidence of stroke recurrence (P=1.000) and clinical events (P=0.739) between the two groups during the long-term follow-up period.
Conclusions:It is safe to use agatraban anticoagulant therapy in the vertebral artery stenting. Continuous use of agatraban anticoagulation after procedure may effectively reduce the increase of stent stenosis at 6 months after procedure.
