Key result
Following carotid endarterectomy, dual antiplatelet therapy was associated with lower late restenosis >50% compared to single therapy (17.6% vs 31.6%; OR 0.48, 95% CI 0.30-0.76, p=0.002).
Why the study?
Antiplatelet therapy is central to managing carotid artery disease after carotid endarterectomy, but data regarding the effect of dual antiplatelet therapy on restenosis rates remain scarce.
Does dual antiplatelet therapy reduce restenosis in patients following carotid endarterectomy compared to single antiplatelet therapy?
Cohort (n=1,453)
No
Does dual antiplatelet therapy reduce restenosis in patients following carotid endarterectomy compared to single antiplatelet therapy?
Odds Ratio: 0.48 (95% CI 0.3–0.76)
Absolute Event Rate: 17.6% vs 31.6%
p-value: p=0.002
Dual antiplatelet therapy following carotid endarterectomy is associated with lower rates of late restenosis compared to single antiplatelet therapy, though without a significant difference in the need for reintervention.
May support DAPT to lower late restenosis after CEA; hypothesis-generating and requires randomized confirmation before practice change.
BACKGROUND: Antiplatelet therapy is a cornerstone in the management of carotid artery disease following carotid endarterectomy (CEA). There is a paucity of data regarding the effect of dual antiplatelet therapy (DAPT) on restenosis rates. METHODS: A retrospective review of patients who underwent CEA from January 1, 2007 to December 31, 2013 was performed at a single center. Study groups consisted of subjects who received DAPT and those who received single antiplatelet therapy (SAPT) following CEA. Restenosis was evaluated by carotid duplex. Severity and timing of restenosis, postoperative complications, and reinterventions were compared between study groups. RESULTS: Between January 1, 2007 and December 31, 2013, 1453 patients underwent CEA. The SAPT group consisted of 245 patients and the DAPT group consisted of 1208 patients. No difference in restenosis was identified between groups at less than 6 weeks (6.5% vs. 11.7% 50-79% stenosis, 0% vs. 2.2% 80-99% stenosis, 2.2% vs. 0.6% occlusion, p = 0.368), and 6 weeks to 2 years (20.6% vs. 17.9% 50-79% stenosis, 1.1% vs. 1.0% 80-99% stenosis, 1.6% vs. 0.4% occlusion, p = 0.242). A higher rate of restenosis in SAPT was found greater than 2 years from surgery (68.4% vs. 82.4% <50% stenosis, 29.9% vs. 16.1% 50-79% stenosis, 0% vs. 0.6% 80-99% stenosis, 1.7% vs. 0.9% occlusion p = 0.004). This finding persisted on multivariable analysis with 31.6% of the SAPT group showing >50% stenosis vs. 17.6% of the DAPT group (adjusted OR 0.48, 95% CI 0.30-0.76, p = 0.002). In a propensity matched-population, 32.7% of the SAPT group demonstrated restenosis vs. 13.7% of the DAPT group (adjusted OR 0.35, 95% CI 0.16-0.77, p = 0.009). There was no difference in the need for reintervention between study groups (DAPT 3.8% vs SAPT 3.3%, p = 0.684). CONCLUSION: Following CEA, patients on DAPT exhibited lower rates of late restenosis. Despite this finding, a clinical difference in reintervention was not found during this study period.
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Glotzer et al. (2020) conducted a cohort in Carotid artery disease following carotid endarterectomy (n=1,453). Dual antiplatelet therapy (DAPT) vs. Single antiplatelet therapy (SAPT) was evaluated on Late restenosis (>50% stenosis) at greater than 2 years (OR 0.48, 95% CI 0.30-0.76, p=0.002). Following carotid endarterectomy, dual antiplatelet therapy was associated with lower late restenosis >50% compared to single therapy (17.6% vs 31.6%; OR 0.48, 95% CI 0.30-0.76, p=0.002).
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