The Use Of Antiplatelet Medications Is Associated With Decreased Brain Parenchymal Involvement In Symptomatic Patients Who Undergo Carotid Intervention
Katherine Teter, MD, Loes Willems, MD, Jason Zhang, MD, Keerthi Harish, Bruck Negash, Caron Rockman, MD, Jose Torres, MD, Koto Ishida, MD, Karan Garg, MD, Thomas Maldonado, MD.
NYU Langone Health, New York, NY, USA.
OBJECTIVES: Carotid interventions are indicated for symptomatic and severe asymptomatic carotid artery stenosis (CAS). Symptomatic CAS accounts for 12-25% of overall carotid interventions, but predictors of symptomatic presentation remain poorly defined. The aim of this study was to identify factors associated with symptomatic CAS in our patient population.
METHODS: Between January 2015 and February 2022, an institutional retrospective cohort study of prospectively collected data on patients undergoing interventions for CAS was performed. Procedures included carotid endarterectomy (CEA), transcarotid artery revascularization (TCAR), and transfemoral carotid artery stenting (TF-CAS). Demographic data, comorbidities, procedural details, and anatomic features from imaging modalities were collected. Comparisons were made between symptomatic and asymptomatic patients. RESULTS: During the study period, 279 patients who underwent intervention for symptomatic CAS were paired with a randomly selected cohort of 300 patients who underwent intervention for asymptomatic CAS from a total patient cohort of 1143 patients undergoing interventions for CAS. Demographics did not differ between groups. Patients with symptomatic CAS more frequently had prior TIA/stroke (remote to the current event), but less frequently had coronary artery disease or chronic kidney disease and were less likely to receive adequate medical management including anti-hypertensive agents, lipid-lowering agents, and anti-platelet therapy. On multivariate analysis, remote prior TIA/stroke and lack of anti-platelet therapy remained significant. Lack of anti-platelet therapy in symptomatic patients was associated with an overall larger area of parenchymal involvement for patients with strokes. No difference was observed with single versus dual anti-platelet therapy. Furthermore, symptomatic patients were more likely to have ulcerated plaques (30.9% vs. 18%, p<0.001), and symptomatic patients with ulcerated plaques more frequently had mild compared to moderate/severe CAS. Nine patients who presented with symptoms had mild CAS and underwent intervention. CONCLUSIONS: Symptomatic CAS was associated with history of remote prior symptoms and lack of anti-platelet therapy at time of presentation. Furthermore, symptomatic patients not on anti-platelet agents were more likely to have a greater area of parenchymal involvement when presenting with stroke and symptomatic patients with ulcerated plaques were more likely to have mild CAS, suggesting the role of plaque instability in symptomatic presentation. These findings underscore the importance of appropriate medical management and adherence in all patients with CAS and perhaps a role for increased surveillance in those with potentially unstable plaque morphology.
Back to 2023 Abstracts