Impact Of Dual Antiplatelet Therapy On Long Term Outcomes Of Complete Internal Carotid Artery Occlusion In A Veteran Cohort
Mihai Bentan, James Dittman, Sally Boyd, MD, Kedar Lavingia, MD, Michael F. Amendola, MD.
VA Medical Center/VCU Health System, Richmond, VA, USA.
OBJECTIVES: Dual antiplatelet therapy (DAPT) is the first line therapy for cerebrovascular accident (CVA) reduction in the setting of known internal carotid artery (ICA) occlusions. Data suggests a decreased rate of stenotic progression in non-occlusions on DAPT compared to aspirin alone. This assertion has not been studied in the setting of ipsilateral internal carotid artery occlusions. We set forth to examine the impact of DAPT on incidence of contralateral ICA stenosis and other outcomes in patients with ultrasound doppler exam (UDE) diagnosed complete ICA occlusion in a veteran cohort. METHODS:Following IRB approval (IRB#1622703), all patients undergoing UDE at a single VA Health Care System from 2015 to 2019 were reviewed for ICA occlusion. The DAPT cohort was defined by simultaneous aspirin and Plavix use at UDE. Demographics, comorbidities, medication regime, and incidence of CVA, myocardial infarction (MI), mortality, and contralateral ICA intervention and stenosis progression to 70% occlusion were recorded. Student’s t-test* and Fisher’s Exact Test** were utilized to compare cohorts. RESULTS:Of 3,619 patients who underwent UDE, 95 patients were found to have an ICA occlusion. Of these, 30 patients (31.6%) were treated with DAPT. There were no significant differences between average age (65.6±6.7 vs 68.2±9.4; p=0.2*), statin use (90% vs 91%; p=1.0**), anticoagulation use (7% vs 23%; p=0.08**), comorbidities, and most outcomes between DAPT and non-DAPT cohorts. 69 patients received follow-up UD for an average of 5.0 ± 4.2 years, with no significant difference in contralateral progression between DAPT and non-DAPT (4% vs 11%; p=0.7**) in this subset. CONCLUSIONS:In patients with newly diagnosed ICA occlusion, DAPT use increased average time to contralateral intervention but did not significantly impact long-term CVA, MI, or mortality. These data further delineate the potential benefit of DAPT in the setting of ICA occlusion and warrant further study. 
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