The efficacy and safety of carotid stenting under dual antiplatelet therapy with ticagrelor and acetylsalicylic acid

Abstract

Aim: To prevent thrombotic complications in carotid artery stenting (CAS), it is recommended to use acetylsalicylic acid (ASA) and clopidogrel for at least one month, followed by single antiplatelet therapy. The number of studies on the use of ticagrelor in CAS is very few. We aimed to evaluate the efficacy and safety of ticagrelor in CAS in this study. Methods: The records of the patients who underwent CAS between January 2020 and January 2022 were scanned and the patients who were treated with the ASA and ticagrelor therapy were included in this study. Demographic data of the patients, vascular risk factors, ipsilateral-contralateral stenosis rates, balloon angioplasty application status, residual stenosis rates, periprocedural ischemic and hemorrhagic events, and vascular events developed during three-month follow-up were noted. Results: Thirteen patients were included in the present study. Their mean age was 69.38±7.1 years. The mean carotid stenosis rate was 82.07±10.44%, and contralateral stenosis rate was 65.07±32.98%. Stent thrombosis was not observed in any patient. After the procedure, minor ischemic stroke that did not cause disability developed in one patient and puncture site bleeding that did not require transfusion in one patient. One patient had >50% restenosis at three months. Conclusion: The findings suggest that dual antiplatelet therapy with ticagrelor + ASA appears to be a safe and effective treatment for CAS. Given that clopidogrel resistance cannot be evaluated in many centers, it may be more accurate to prefer ticagrelor, especially in high-risk patients with bilateral stenosis.

Keywords

• Carotid artery
• clopidogrel
• stent
• stroke
• ticagrelor