Yonsei Med J.  2013 Mar;54(2):288-294. 10.3349/ymj.2013.54.2.288.

The Influence of Anti-Platelet Resistance on the Development of Cerebral Ischemic Lesion after Carotid Artery Stenting

• Song TJ
• Suh SH
• Min PK
• Kim DJ
• Kim BM
• Heo JH
• Kim YD
• Lee KY

• KMID: 1503887
• DOI: http://doi.org/10.3349/ymj.2013.54.2.288

Abstract

PURPOSE
Cerebral ischemic lesions are frequently observed after carotid artery stenting (CAS), and anti-platelet agents are used to prevent stent thrombosis and peri-procedural complications. However, despite the premedication, cerebral ischemic lesions are observed, suggesting that they may rather be related to anti-platelet resistance. We, therefore, investigated the effects of anti-platelet resistance on the development of cerebral ischemic lesions after CAS.
MATERIALS AND METHODS
We retrospectively reviewed patients who received CAS and selected patients for whom brain MRI was performed within 24 hours after CAS and for whom anti-platelet resistance was checked. Anti-platelet resistance was examined by the VerifyNow system. We analyzed the correlation between anti-platelet resistance and cerebral ischemic lesions detected on follow-up MRI.
RESULTS
Among 76 patients, 45 (59.2%) developed new ischemic lesions after CAS. Twelve (15.8%) patients showed aspirin resistance and 50 (65.8%) patients showed clopidogrel resistance. Patients with a new ischemic lesion demonstrated a significantly greater frequency of clopidogrel resistance than those who had no new ischemic lesion (82.2% versus 41.9%, p=0.001). The frequency of aspirin resistance was not significantly different between the groups of patients with and without new ischemic lesions (20.0% versus 9.7%, p=0.340). In multivariate analysis, clopidogrel resistance was a significant risk factor for post-procedural cerebral ischemia.
CONCLUSION
Anti-platelet resistance can be used to predict new ischemic lesions after CAS. Anti-platelet resistance should be evaluated in all patients prior to CAS to prevent ischemic complications related to CAS.

Keyword

Cerebral infarction; aspirin resistance; clopidogrel resistance; carotid artery stent

MeSH Terms

Aged
Aspirin/*therapeutic use
Brain Ischemia/diagnosis/*etiology
Carotid Arteries/*surgery
*Drug Resistance
Female
Humans
Male
Middle Aged
Multivariate Analysis
Platelet Aggregation Inhibitors/*therapeutic use
Retrospective Studies
Stents/*adverse effects
Platelet Aggregation Inhibitors
Aspirin

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