1Department of Clinical Neurosciences, University of Calgary.
2Hotchkiss Brain Institute, University of Calgary.
J Neurosurg. 2023 Jan 27;139(3):661-669. doi: 10.3171/2022.12.JNS222316. Print 2023 Sep 1.
Routine antiplatelet responsiveness testing for patients undergoing carotid artery stenting procedures is not performed at most endovascular centers and remains a topic of controversy within the neurointerventional community. The objective of this study was to determine if nonresponsiveness to acetylsalicylic acid or clopidogrel was associated with the development of symptomatic thromboembolic events in patients undergoing carotid stenting procedures.
A prospective study was conducted at the Foothills Medical Centre in Calgary, Alberta, Canada, from August 2019 to July 2021. Patients undergoing carotid artery stenting procedures and who were receiving dual antiplatelet therapy were enrolled in the study. Responsiveness to the antiplatelet medications was determined through whole blood impedance aggregometry. The primary outcome was development of a symptomatic thromboembolic event within 90 days after the procedure. The treating physicians were blinded to the aggregometry results for the duration of the study.
One hundred two procedures were performed in 100 patients. Eight thromboembolic events (8%) occurred during the study. Age (p = 0.03) and nonresponsiveness to clopidogrel (p = 0.003) were associated with the development of thromboembolic events. The multivariable model showed that clopidogrel nonresponsiveness was independently associated with the development of a thromboembolic event (adjusted OR 6.14, 95% CI 1.25-30.11, p = 0.03).
This study demonstrated that patients who were identified as clopidogrel nonresponders, using whole blood impedance aggregometry, were at an increased risk of developing thromboembolic events. Larger studies are needed to assess the utility of routine platelet function testing prior to carotid artery stenting procedures.
大多数血管内治疗中心并未对行颈动脉支架置入术的患者进行常规抗血小板反应性检测，这在神经介入领域仍是一个有争议的话题。本研究旨在确定阿司匹林或氯吡格雷无反应是否与行颈动脉支架置入术患者发生症状性血栓栓塞事件有关。
本前瞻性研究于 2019 年 8 月至 2021 年 7 月在加拿大艾伯塔省卡尔加里的山麓医疗中心进行。纳入正在接受双联抗血小板治疗并行颈动脉支架置入术的患者。通过全血阻抗聚集法测定抗血小板药物的反应性。主要结局为术后 90 天内发生症状性血栓栓塞事件。在研究期间，治疗医生对聚集结果不知情。
100 例患者的 102 例手术中，8 例（8%）发生血栓栓塞事件。年龄（p = 0.03）和对氯吡格雷无反应（p = 0.003）与血栓栓塞事件的发生有关。多变量模型显示，氯吡格雷无反应与血栓栓塞事件的发生独立相关（调整后的 OR 6.14，95%CI 1.25-30.11，p = 0.03）。
本研究表明，使用全血阻抗聚集法确定的氯吡格雷无反应患者发生血栓栓塞事件的风险增加。需要更大规模的研究来评估在颈动脉支架置入术之前进行常规血小板功能检测的效用。
