Abstract Body: Introduction

Patients undergoing carotid artery stenting (CAS) are placed on dual antiplatelet therapy (DAPT) to minimize the risk of thromboembolic complications. DAPT carries a risk of thromboembolic events in hypo-responders or hemorrhagic events in hyper-responders to clopidogrel. Despite platelet function testing (PFT) being routinely performed, recent literature has reported varying efficacy in its utility in preventing complications after neurointerventional procedures. Our study evaluates the efficacy of PFT after extracranial CAS.

Methods

This was a retrospective study of patients who underwent extracranial CAS at our institution from July 2019- March 2023. Patients were dichotomized based on whether they underwent PFT and their subsequent P2Y12- guided antiplatelet regimen of either aspirin (ASA)/ clopidogrel or ASA/ ticagrelor. Outcomes of interest were peri-procedural hemorrhagic complications and follow-up ischemic complications.

Results

Of 280 patients who underwent extracranial CAS, 47.1% (n= 132) underwent PFT. Among patients who developed a peri-procedural hemorrhagic complication (2.1%, n= 6), 83.3% (n= 5) had their P2Y12 levels drawn (P= 0.073) (Table 1). Among 215 patients who had follow up data, 27.4% (n= 59) developed an ischemic complication and 52.5% (n= 31) had their P2Y12 levels drawn (P= .178). There was no significant difference in rates of peri-procedural hemorrhagic complications (2.9% vs. 0%) or follow-up ischemic complications (23.4% vs. 25.0) across cohorts based on P2Y12 testing.

On multivariate regression, peripheral vascular disease was associated with a 2.36-fold higher odds (95% CI: 1.04- 5.36, P<0.05) of developing a follow-up ischemic complication (Table 2). ASA/ ticagrelor regimen on discharge had a 2.16-fold higher odds (95% CI: 1.04- 4.49, P<0.05) of developing ischemic complications compared to ASA/ clopidogrel.

Conclusion

Our study revealed significantly higher rates of follow up ischemic complications after the use of ASA/ticagrelor compared to ASA/ clopidogrel. This association was independent of having P2Y12 levels checked.