Antithrombotic drugs in peripheral arterial diseases

ESC CardioMed ◽  
2018 ◽  
pp. 2699-2703
Author(s):  
Jean Philippe Collet
Keyword(s):  
Carotid Artery ◽  
Antiplatelet Therapy ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Clinical Symptoms ◽  
Anticoagulation Therapy ◽  
Antiplatelet Drug ◽  
Revascularization Procedure ◽  
Peripheral Arterial Diseases ◽  
Peripheral Arterial

Antiplatelet therapy is indicated in all patients with carotid artery stenosis irrespective of clinical symptoms and revascularization. Dual antiplatelet therapy should be given for at least one month after carotid artery stenting. Single antiplatelet therapy is indicated only if LEAD patients are symptomatic or have undergone revascularization. Clopidogrel is the preferred antiplatelet drug in LEAD patients. Chronic anticoagulation therapy is given only if there is a concomitant indication and may be combined with single antiplatelet therapy when there is a recent revascularization procedure.

scholarly journals Subcutaneous Hematoma Associated with Manual Cervical Massage during Carotid Artery Stenting

2011 ◽  
Vol 17 (3) ◽  
pp. 386-390 ◽  
Author(s):  
A. Tsurumi ◽  
Y. Tsurumi ◽  
M. Negoro ◽  
K. Yokoyama ◽  
M. Oheda ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Antiplatelet Therapy ◽  
Carotid Artery Stenting ◽  
Dual Antiplatelet Therapy ◽  
Anticoagulation Therapy ◽  
Balloon Occlusion ◽  
Cervical Region ◽  
Manual Compression ◽  
Stenotic Lesion ◽  
Distal Side

We describe a patient with subcutaneous hematoma associated with manual cervical massage during carotid artery stenting. A 73-year-old man with left cervical carotid artery stenosis presented with left amaurosis fugax. We performed carotid artery stenting using distal embolic protection with balloon occlusion. Dual antiplatelet therapy was maintained in the periprocedural period and an anticoagulant agent was administered during the procedure. Because the aspiration catheter became entrapped by the stent, it did not reach the distal side of the stenotic lesion, and manual compression of the cervical region was therefore performed. Immediately afterwards, a subcutaneous hemorrhage occurred in the cervical region. There was no postoperative dyspnea due to enlargement of the hematoma, which was absorbed spontaneously. Cervical subcutaneous hematoma can occur in the cervical region due to cervical massage in patients who are receiving adjuvant antiplatelet therapy and anticoagulation therapy.

Abstract TP140: Impact of Pre-procedural Antiplatelet Therapy on Vascular Events After Carotid Artery Stenting: Investigation on Devices and Anti-platelet Therapy for Carotid Artery Stenting (IDEALCAST)

Stroke ◽  
2013 ◽  
Vol 44 (suppl_1) ◽  
Author(s):  
Hiroshi Yamagami ◽  
Nobuyuki Sakai ◽  
Yoshihiro Matsubara ◽  
Yasushi Okada ◽  
Hiroyoshi Yokoi ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Antiplatelet Therapy ◽  
Primary Endpoint ◽  
Carotid Artery Stenting ◽  
Controlled Trial ◽  
Antiplatelet Drug ◽  
Vascular Events ◽  
Multicenter Observational Study ◽  
Significant Difference ◽  
History Of

Background and Purpose: Dual antiplatelet therapy (DAPT) with aspirin and clopidogrel is recommended for a standard pre-procedural management for carotid artery stenting (CAS). However, impact of other pre-procedural antiplatelet drug on vascular events after CAS is still unknown. Methods: In a prospective, multicenter, observational study, we analyzed data from 934 patients underwent elective CAS for > 50 % stenosis in symptomatic or > 80% stenosis in asymptomatic carotid arteries. Data on pre-procedural antiplatelet drugs was obtained at patients’ enrollment, and all patients were followed for 1 year after the stenting. The primary endpoint was the composite of death, any stroke, transient ischemic attack, myocardial infarction, and serious systemic bleeding. Results: Of the 934 patients (818 men, 72 ± 7 years old), 476 patients were treated with aspirin and clopidogrel (51.0%, A+CLP group), 162 with aspirin and cilostazol (17.3%, A+CSZ group), 62 with clopidogrel and cilostazol (6.6%, CLP+CSZ group), 118 with asprin, clopidogrel and cilostazol (12.6%, TAPT group), and 116 with other combinations (12.4%, Other group). As patients background, a history of ischemic stroke was more frequent in A+CSZ and CLP+CSZ groups, and a history of ischemic heart disease or revascularization was more frequent in A+CLP and TAPT groups than in other groups. There was no significant difference in other factors. Incidences of primary endpoint were as follows: 12.6% in A+CLP, 5.6% in A+CSZ, 8.1% in CLP+CSZ, 14.4% in TAPT, and 15.5% in Other group. In multivariate analysis, combination of aspirin and cilostazol was associated with lower risk for primary endpoint compared with aspirin and clopidogrel (hazard ratio, 0.39; 95% confidence interval, 0.18 to 0.75, P=0.004). Conclusions: Combination of aspirin and cilostazol can decrease the risk of vascular events or death after CAS. A prospective randomized controlled trial is necessary to clarify the effect of pre-procedural antiplatelet therapy on vascular events after CAS.

Increased Rates of Hemorrhages after Endovascular Stroke Treatment with Emergency Carotid Artery Stenting and Dual Antiplatelet Therapy

2021 ◽  
pp. 1-9
Author(s):  
Felix Hadler ◽  
Raveena Singh ◽  
Martin Wiesmann ◽  
Arno Reich ◽  
Omid Nikoubashman
Keyword(s):  
Risk Factors ◽  
Carotid Artery ◽  
Antiplatelet Therapy ◽  
Carotid Artery Stenting ◽  
Dual Antiplatelet Therapy ◽  
Stroke Treatment ◽  
Systemic Thrombolysis ◽  
Stroke Registry ◽  
Increased Risk ◽  
Arterial Thrombolysis

<b><i>Background:</i></b> While endovascular stroke treatment (EST) of large vessel occlusions in acute ischemic stroke (AIS) is proven to be safe and effective, there are subgroups of patients with increased rates of hemorrhages. Our goal was to identify risk factors for intracerebral hemorrhage and to assess whether acute carotid artery stenting (CAS) was associated with increased bleeding rates. <b><i>Methods:</i></b> We performed a retrospective analysis of our monocentric prospective stroke registry in the period from May 2010 to May 2018 and compared AIS patients receiving EST with (<i>n</i> = 73) versus without acute CAS (<i>n</i> = 548). Patients with intracranial stents, intra-arterial thrombolysis, or dissection of the carotid artery were excluded. <b><i>Results:</i></b> Parenchymal hemorrhage rates (PH2 according to the ECASS classification) and symptomatic hemorrhage (sICH) rates were increased in EST patients receiving CAS with odds being 6.3 (PH2) and 6.5 (sICH) times higher (PH2 17.8 vs. 3.3%, <i>p</i> &#x3c; 0.001 and sICH: 16.4 vs. 2.9%, <i>p</i> &#x3c; 0.001). Additional systemic thrombolysis with rtPA (IVRTPA) was no risk factor for cerebral hemorrhage (<i>p</i> = 0.213). <b><i>Conclusion:</i></b> AIS patients receiving EST with acute CAS and consecutive tirofiban or dual antiplatelet therapy suffered from an increased risk of relevant secondary intracranial bleeding. After adjusting for confounders, tirofiban and dual antiplatelet therapy were associated with higher bleeding rates.

Endovascular Advances for Extracranial Carotid Stenosis

Neurosurgery ◽  
2014 ◽  
Vol 74 (suppl_1) ◽  
pp. S92-S101 ◽  
Author(s):  
Jorge L. Eller ◽  
Travis M. Dumont ◽  
Grant C. Sorkin ◽  
Maxim Mokin ◽  
Elad I. Levy ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Carotid Stenting ◽  
Historical Background ◽  
Treatment Modalities ◽  
Endovascular Management ◽  
The Past

Abstract Carotid artery stenting has become a viable alternative to carotid endarterectomy in the management of carotid stenosis. Over the past 20 years, many trials have attempted to compare both treatment modalities and establish the indications for each one, depending on clinical and anatomic features presented by patients. Concurrently, carotid stenting techniques and devices have evolved and made endovascular management of carotid stenosis safe and effective. Among the most important innovations are devices for distal and proximal embolic protection and new stent designs. This paper reviews these advances in the endovascular management of carotid artery stenosis within the context of the historical background.

scholarly journals Effect of Carotid Artery Stenting on Cognitive Function in Patients With Carotid Artery Stenosis: Preliminary Results

2008 ◽  
Vol 29 (2) ◽  
pp. 265-268 ◽  
Author(s):  
A.S. Turk ◽  
I. Chaudry ◽  
V.M. Haughton ◽  
B.P. Hermann ◽  
H.A. Rowley ◽  
...  
Keyword(s):  
Cognitive Function ◽  
Carotid Artery ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Artery Stenosis ◽  
Preliminary Results

Transcarotid Artery Revascularization and Advances in Vascular Surgery for Carotid Artery Disease

2021 ◽  
Author(s):  
James Hu ◽  
◽  
Andy Sohn ◽  
Justin George ◽  
Rajesh Malik ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Vascular Surgery ◽  
Carotid Endarterectomy ◽  
Surgical Management ◽  
Carotid Artery Stenosis ◽  
Carotid Artery Stenting ◽  
Carotid Artery Disease ◽  
Artery Stenosis ◽  
Cerebrovascular Accidents ◽  
Artery Disease

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

scholarly journals Carotid Artery Stenting to Prevent Stroke in a Patient with Bilateral Extracranial Internal Carotid Dissection and Vasospasm following Rupture of an Intracranial Aneurysm

2003 ◽  
Vol 9 (3) ◽  
pp. 305-310 ◽  
Author(s):  
J. Sedat ◽  
M. Dib ◽  
J. Szapiro ◽  
P. Paquis
Keyword(s):  
Cerebral Ischemia ◽  
Carotid Artery ◽  
Intracranial Aneurysm ◽  
Carotid Artery Stenting ◽  
Internal Carotid ◽  
Anticoagulation Therapy ◽  
Clinical Grade ◽  
Carotid Dissection ◽  
Aneurysmal Rupture ◽  
Therapeutic Anticoagulation

The stenting of carotid dissection has been described for the prevention of cerebral ischemia in patients who remain symptomatic despite therapeutic anticoagulation, in those who present contraindications for anticoagulation therapy, or who present a local or extensive stenosis, with an associated pseudoaneurysm. We here report a case associating a high clinical grade aneurysmal rupture with a bilateral extracranial carotid dissection. Because of the haemodynamic risk due to the acute bilateral stenosis-induced dissection and the occurrence of a vasospasm, the carotid dissections were treated with self-expendable stents.

Sign in / Sign up

Export Citation Format

Share Document