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Cohen JE, Gomori JM, Honig A, et al. Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy. J Clin Med. 2021;10(22)doi: 10.3390/jcm10225242.
Cohen, J. E., Gomori, J. M., Honig, A., & Leker, R. R. (2021). Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy. Journal of clinical medicine, 10(22), . https://doi.org/10.3390/jcm10225242
Cohen, José E, et al. "Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy." Journal of clinical medicine vol. 10,22 (2021). doi: https://doi.org/10.3390/jcm10225242
Cohen JE, Gomori JM, Honig A, Leker RR. Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy. J Clin Med. 2021 Nov 11;10(22). doi: 10.3390/jcm10225242. PMID: 34830524; PMCID: PMC8620833.
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J Clin Med. 2021 Nov 11;10(22). doi: 10.3390/jcm10225242.

Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy.

Journal of clinical medicine

José E Cohen, John Moshe Gomori, Asaf Honig, Ronen R Leker

Affiliations

  1. Departments of Neurosurgery and Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
  2. Department of Radiology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.
  3. Department of Neurology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel.

PMID: 34830524 PMCID: PMC8620833 DOI: 10.3390/jcm10225242

Abstract

Carotid endarterectomy is usually preferred over carotid artery stenting (CAS) for patients with atrial fibrillation (AF). We present our experience with short-course periprocedural triple antithrombotic therapy in 32 patients aged >18 years with nonvalvular AF undergoing CAS. There were no deaths, cardiac events, embolic strokes, hyperperfusion syndrome, intracranial hemorrhage, or stent thrombosis within 30 days. Transient intraprocedural hemodynamic instability in 15/32 (47%) and prolonged instability in 4/32 (13%) was managed conservatively. At a mean 16-month follow-up, there were no new neurological events or deterioration. Mean stenosis was reduced from 78.0% ± 9.7% to 17.3% ± 12.2%. This retrospective study included patients AF who were symptomatic (minor stroke (NIHSS ≤ 5)/TIA) with ICA stenosis >50%, or asymptomatic under DOAC therapy with carotid stenosis >80%, who underwent CAS from 6/2014-10/2020. Patients received double antiplatelets and statins. Antiplatelet therapy effectiveness was monitored. Stenting was performed when P2Y12 reaction units (PRU) were <150. DOACs were discontinued 48 h before angioplasty; one 60 mg dose of subcutaneous enoxaparin was administered in lieu. DOAC was restarted 12-24 h after intervention. Patients were discharged under DOAC and one nonaspirin antiplatelet. 32 patients on DOAC were included (26 male, mean age 71). 19 (59.4%) presented with stroke (ICA stenosis-related in 14); 13 (40.6%) were asymptomatic. Stents were deployed under filter protection following pre-angioplasty; post-angioplasty was performed at least once in 12 patients (37.5%). Our experience suggests that CAS can be safely performed in selected patients with CAS and AF requiring DOAC. The role of CAS in AF patients under DOAC warrants study in rigorous trials.

Keywords: anticoagulation; antiplatet regimen; atrial fibrillation; carotid artery stenting; carotid stenosis; ischemic stroke

References

  1. JAMA. 1995 May 10;273(18):1421-8 - PubMed
  2. Clin Epidemiol. 2014 Jun 16;6:213-20 - PubMed
  3. Eur J Vasc Endovasc Surg. 2017 Jan;53(1):53-67 - PubMed
  4. Arch Intern Med. 2010 Sep 13;170(16):1433-41 - PubMed
  5. Eur Heart J. 2018 May 14;39(19):1726-1735a - PubMed
  6. AJNR Am J Neuroradiol. 2008 Apr;29(4):786-91 - PubMed
  7. J Neurol Sci. 2020 Feb 15;409:116590 - PubMed
  8. Chest. 2010 Feb;137(2):263-72 - PubMed
  9. J Vasc Surg. 2005 Feb;41(2):223-30 - PubMed
  10. N Engl J Med. 2016 Dec 22;375(25):2423-2434 - PubMed
  11. J Am Coll Cardiol. 2014 Feb 25;63(7):619-629 - PubMed
  12. N Engl J Med. 1990 Nov 29;323(22):1556-8 - PubMed
  13. Stroke. 2003 Nov;34(11):2568-73 - PubMed
  14. Eur Heart J Cardiovasc Pharmacother. 2021 May 23;7(3):218-224 - PubMed
  15. Am J Cardiol. 2020 Feb 15;125(4):521-527 - PubMed
  16. J Vasc Surg. 2010 Feb;51(2):330-6 - PubMed
  17. J Vasc Surg. 2005 Nov;42(5):829-36; discussion 836-7 - PubMed
  18. J Stroke Cerebrovasc Dis. 2014 Feb;23(2):e73-83 - PubMed
  19. N Engl J Med. 2019 Apr 18;380(16):1580-1581 - PubMed
  20. J Cardiovasc Surg (Torino). 2017 Apr;58(2):143-151 - PubMed
  21. J Vasc Surg. 2001 Oct;34(4):581-6 - PubMed
  22. J Neurosurg. 2018 Oct;129(4):890-905 - PubMed
  23. Lancet. 2013 Mar 30;381(9872):1107-15 - PubMed
  24. N Engl J Med. 2017 Oct 19;377(16):1513-1524 - PubMed
  25. Stroke. 1999 Sep;30(9):1751-8 - PubMed
  26. J Thromb Haemost. 2007 Dec;5(12):2429-36 - PubMed
  27. Neurology. 1993 Jan;43(1):32-6 - PubMed
  28. Circulation. 2019 Jul 9;140(2):e125-e151 - PubMed
  29. Arch Intern Med. 1994 Jun 27;154(12):1372-7 - PubMed
  30. Circulation. 2012 Nov 13;126(20):e322; author reply e323 - PubMed

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