Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK; Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
Nuffield Department of Surgical Sciences, University of Oxford, John Radcliffe Hospital, Oxford, UK.
Eur J Vasc Endovasc Surg. 2016 Mar;51(3):336-42. doi: 10.1016/j.ejvs.2015.11.002. Epub 2015 Dec 21.
Strokes are infrequent but potentially serious complications following carotid intervention, but antiplatelet therapy can reduce these risks. There are currently no specific guidelines on dose or duration of peri-procedural antiplatelet treatment for patients undergoing carotid intervention. Within the ongoing Asymptomatic Carotid Surgery Trial-2 (ACST-2), this study aimed at assessing the current use of antiplatelet therapy before, during, and after CEA and CAS in patients with asymptomatic carotid stenosis.
Questionnaires were sent to ACST-2 collaborators seeking information about the use of antiplatelet therapy during the pre-, peri-, and post-operative periods in patients undergoing carotid intervention at 77 participating sites and also whether sites tested for antiplatelet therapy resistance.
The response rate was 68/77 (88%). For CAS, 82% of sites used dual antiplatelet therapy (DAPT) pre-operatively and 86% post-operatively with a mean post-procedural duration of 3 months (range 1-12), while 9% continued DAPT life-long. For CEA only 31% used DAPT pre-operatively, 24% post-operatively with a mean post-procedural duration of 3 months (range 1-5), while 10% continued DAPT life-long. For those prescribing post-procedural mono antiplatelet (MAPT) therapy (76%), aspirin was more commonly prescribed (59%) than clopidogrel (6%) and 11% of centres did not show a preference for either aspirin or clopidogrel. Eleven centres (16%) tested for antiplatelet therapy resistance.
There appears to be broad agreement on the use of antiplatelet therapy in ACST-2 patients undergoing carotid artery stenting and surgery. Although evidence to help guide the duration of peri-procedural antiplatelet therapy is limited, long-term treatment with DAPT appears similar between both treatment arms.
中风是颈动脉介入治疗后罕见但潜在严重的并发症，但抗血小板治疗可以降低这些风险。目前，对于接受颈动脉介入治疗的患者，围手术期抗血小板治疗的剂量或持续时间尚无具体指南。在正在进行的无症状颈动脉手术试验-2（ACST-2）中，本研究旨在评估无症状颈动脉狭窄患者行颈动脉内膜切除术（CEA）和颈动脉支架置入术（CAS）前、中、后抗血小板治疗的现状。
向 ACST-2 合作者发送问卷，以了解 77 个参与站点的患者在颈动脉介入治疗期间术前、术中和术后使用抗血小板治疗的情况，以及站点是否检测抗血小板治疗抵抗。
应答率为 68/77（88%）。对于 CAS，82%的站点在术前使用双联抗血小板治疗（DAPT），86%的站点在术后使用 DAPT，术后平均持续时间为 3 个月（范围 1-12 个月），而 9%的站点终生使用 DAPT。对于 CEA，只有 31%的站点在术前使用 DAPT，24%的站点在术后使用 DAPT，术后平均持续时间为 3 个月（范围 1-5 个月），而 10%的站点终生使用 DAPT。对于那些开具术后单药抗血小板（MAPT）治疗的医生（76%），阿司匹林的使用更为常见（59%），氯吡格雷的使用（6%）较少，11%的中心对阿司匹林和氯吡格雷没有偏好。11 个中心（16%）检测了抗血小板治疗抵抗。
在接受颈动脉支架置入术和手术治疗的 ACST-2 患者中，抗血小板治疗的使用似乎得到了广泛认同。尽管指导围手术期抗血小板治疗持续时间的证据有限，但两种治疗组之间长期使用 DAPT 似乎相似。
