The role of antiplatelet therapy in carotid stenting for ischemic stroke prevention

Seemant Chaturvedi, Jay S. Yadav

Research output: Contribution to journalArticle

70 Citations (Scopus)

Abstract

BACKGROUND AND PURPOSE - Carotid angioplasty and stenting (CAS) is a minimally invasive revascularization procedure that has become a popular and acceptable treatment option in the United States for high surgical risk patients with internal carotid artery atherosclerosis. It is effective and has an acceptable risk profile, but ischemic complications caused by distal embolization and underlying atherothrombosis persist. SUMMARY OF REVIEW - Atherothrombosis is the pathological process that is frequently implicated as the underlying cause of stroke, transient ischemic attacks, and most other ischemic vascular disease. Critical steps in the development of occlusive episodes are the disruption of atherosclerotic plaque and subsequent formation of a platelet-rich mural thrombus. Vascular injury as a result of CAS or any other percutaneous intervention triggers platelet adhesion, activation, and aggregation, resulting in the formation of a mural thrombosis. This risk, in addition to the potential risk of embolization to distal sites, provides a rationale for early antiplatelet therapy with CAS. The risk of late stent (>30 days after stenting) thrombosis in some patients, particularly those receiving drug-eluting stents, provides a rationale for prolonged antiplatelet prophylaxis as well as for prophylaxis against late atherothrombotic events. Because of the systemic and progressive nature of atherothrombosis, protection against ischemic vascular events in other arterial beds expands the benefits of long-term antiplatelet therapy. CONCLUSIONS - As clinical experience with CAS increases, it is likely that it will be used more frequently for patients with occlusive carotid disease. In addition, adjunct antiplatelet therapy will play a key role in the continued development of CAS.

Original languageEnglish (US)
Pages (from-to)1572-1577
Number of pages6
JournalStroke
Volume37
Issue number6
DOIs
StatePublished - Jun 2006
Externally publishedYes

Fingerprint

Angioplasty
Stroke
Thrombosis
Play Therapy
Therapeutics
Carotid Artery Diseases
Drug-Eluting Stents
Vascular System Injuries
Transient Ischemic Attack
Platelet Activation
Internal Carotid Artery
Atherosclerotic Plaques
Pathologic Processes
Secondary Prevention
Vascular Diseases
Platelet Aggregation
Stents
Blood Vessels
Blood Platelets

Keywords

  • Antiplatelets
  • Carotid angioplasty
  • Carotid artery stenosis
  • Stents

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Neuroscience(all)

Cite this

The role of antiplatelet therapy in carotid stenting for ischemic stroke prevention. / Chaturvedi, Seemant; Yadav, Jay S.

In: Stroke, Vol. 37, No. 6, 06.2006, p. 1572-1577.

Research output: Contribution to journalArticle

@article{00ba57b4a25b4b0dbaf7b56301a4a6c3,
title = "The role of antiplatelet therapy in carotid stenting for ischemic stroke prevention",
abstract = "BACKGROUND AND PURPOSE - Carotid angioplasty and stenting (CAS) is a minimally invasive revascularization procedure that has become a popular and acceptable treatment option in the United States for high surgical risk patients with internal carotid artery atherosclerosis. It is effective and has an acceptable risk profile, but ischemic complications caused by distal embolization and underlying atherothrombosis persist. SUMMARY OF REVIEW - Atherothrombosis is the pathological process that is frequently implicated as the underlying cause of stroke, transient ischemic attacks, and most other ischemic vascular disease. Critical steps in the development of occlusive episodes are the disruption of atherosclerotic plaque and subsequent formation of a platelet-rich mural thrombus. Vascular injury as a result of CAS or any other percutaneous intervention triggers platelet adhesion, activation, and aggregation, resulting in the formation of a mural thrombosis. This risk, in addition to the potential risk of embolization to distal sites, provides a rationale for early antiplatelet therapy with CAS. The risk of late stent (>30 days after stenting) thrombosis in some patients, particularly those receiving drug-eluting stents, provides a rationale for prolonged antiplatelet prophylaxis as well as for prophylaxis against late atherothrombotic events. Because of the systemic and progressive nature of atherothrombosis, protection against ischemic vascular events in other arterial beds expands the benefits of long-term antiplatelet therapy. CONCLUSIONS - As clinical experience with CAS increases, it is likely that it will be used more frequently for patients with occlusive carotid disease. In addition, adjunct antiplatelet therapy will play a key role in the continued development of CAS.",
keywords = "Antiplatelets, Carotid angioplasty, Carotid artery stenosis, Stents",
author = "Seemant Chaturvedi and Yadav, {Jay S.}",
year = "2006",
month = "6",
doi = "10.1161/01.STR.0000221298.43117.be",
language = "English (US)",
volume = "37",
pages = "1572--1577",
journal = "Stroke",
issn = "0039-2499",
publisher = "Lippincott Williams and Wilkins",
number = "6",

}

TY - JOUR

T1 - The role of antiplatelet therapy in carotid stenting for ischemic stroke prevention

AU - Chaturvedi, Seemant

AU - Yadav, Jay S.

PY - 2006/6

Y1 - 2006/6

N2 - BACKGROUND AND PURPOSE - Carotid angioplasty and stenting (CAS) is a minimally invasive revascularization procedure that has become a popular and acceptable treatment option in the United States for high surgical risk patients with internal carotid artery atherosclerosis. It is effective and has an acceptable risk profile, but ischemic complications caused by distal embolization and underlying atherothrombosis persist. SUMMARY OF REVIEW - Atherothrombosis is the pathological process that is frequently implicated as the underlying cause of stroke, transient ischemic attacks, and most other ischemic vascular disease. Critical steps in the development of occlusive episodes are the disruption of atherosclerotic plaque and subsequent formation of a platelet-rich mural thrombus. Vascular injury as a result of CAS or any other percutaneous intervention triggers platelet adhesion, activation, and aggregation, resulting in the formation of a mural thrombosis. This risk, in addition to the potential risk of embolization to distal sites, provides a rationale for early antiplatelet therapy with CAS. The risk of late stent (>30 days after stenting) thrombosis in some patients, particularly those receiving drug-eluting stents, provides a rationale for prolonged antiplatelet prophylaxis as well as for prophylaxis against late atherothrombotic events. Because of the systemic and progressive nature of atherothrombosis, protection against ischemic vascular events in other arterial beds expands the benefits of long-term antiplatelet therapy. CONCLUSIONS - As clinical experience with CAS increases, it is likely that it will be used more frequently for patients with occlusive carotid disease. In addition, adjunct antiplatelet therapy will play a key role in the continued development of CAS.

AB - BACKGROUND AND PURPOSE - Carotid angioplasty and stenting (CAS) is a minimally invasive revascularization procedure that has become a popular and acceptable treatment option in the United States for high surgical risk patients with internal carotid artery atherosclerosis. It is effective and has an acceptable risk profile, but ischemic complications caused by distal embolization and underlying atherothrombosis persist. SUMMARY OF REVIEW - Atherothrombosis is the pathological process that is frequently implicated as the underlying cause of stroke, transient ischemic attacks, and most other ischemic vascular disease. Critical steps in the development of occlusive episodes are the disruption of atherosclerotic plaque and subsequent formation of a platelet-rich mural thrombus. Vascular injury as a result of CAS or any other percutaneous intervention triggers platelet adhesion, activation, and aggregation, resulting in the formation of a mural thrombosis. This risk, in addition to the potential risk of embolization to distal sites, provides a rationale for early antiplatelet therapy with CAS. The risk of late stent (>30 days after stenting) thrombosis in some patients, particularly those receiving drug-eluting stents, provides a rationale for prolonged antiplatelet prophylaxis as well as for prophylaxis against late atherothrombotic events. Because of the systemic and progressive nature of atherothrombosis, protection against ischemic vascular events in other arterial beds expands the benefits of long-term antiplatelet therapy. CONCLUSIONS - As clinical experience with CAS increases, it is likely that it will be used more frequently for patients with occlusive carotid disease. In addition, adjunct antiplatelet therapy will play a key role in the continued development of CAS.

KW - Antiplatelets

KW - Carotid angioplasty

KW - Carotid artery stenosis

KW - Stents

UR - http://www.scopus.com/inward/record.url?scp=33745172148&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=33745172148&partnerID=8YFLogxK

U2 - 10.1161/01.STR.0000221298.43117.be

DO - 10.1161/01.STR.0000221298.43117.be

M3 - Article

C2 - 16627791

AN - SCOPUS:33745172148

VL - 37

SP - 1572

EP - 1577

JO - Stroke

JF - Stroke

SN - 0039-2499

IS - 6

ER -