Secondary Prevention after Carotid Stenting in Patients With Atrial Fibrillation

Q: What does this research mean for the field?

Bleeding events, recurrent ischemic stroke, and stent thrombosis rates do not significantly differ among dual antiplatelet therapy, single antiplatelet plus anticoagulation, and triple therapy following carotid artery stenting in patients with atrial fibrillation. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Alex Hanson; Arshaq Saleem; Elena Sagues; A Gudino; Edgar A. Samaniego

doi:10.1177/15385744251387547

October 16, 2025Vascular and Endovascular Surgery

Secondary Prevention after Carotid Stenting in Patients With Atrial Fibrillation

View Full Paper

Ask AI

Bookmark

Share

Why the study?

There is no consensus on the optimal secondary stroke prevention regimen for patients with atrial fibrillation undergoing carotid artery stenting.

Do different antiplatelet and anticoagulation regimens affect bleeding and ischemic outcomes in patients with atrial fibrillation undergoing carotid artery stenting?

Key Points

To compare the efficacy and safety of dual antiplatelet therapy, single antiplatelet therapy plus oral anticoagulation, and triple therapy following carotid artery stenting in patients with pre-existing atrial fibrillation.
Retrospective observational study analyzing 129 patients with atrial fibrillation who underwent carotid artery stenting between 2011 and 2024.
Patients were grouped into dual antiplatelet therapy (DAPT, n=31), single antiplatelet plus oral anticoagulation (AA, n=46), or triple therapy (TT, n=52).
Evaluated primary outcome of major bleeding alongside secondary endpoints of minor bleeding, recurrent stroke, and stent thrombosis at 3 months.
Major bleeding at 3 months occurred in 3.2% (1/31) of patients receiving DAPT, 6.5% (3/46) receiving AA, and 7.7% (4/52) receiving TT (P = 0.71).
Ischemic stroke occurred post-stenting in 6.4% (2/31) of the DAPT group, 4.3% (2/46) of the AA group, and 1.9% (1/52) of the TT group (P = 0.57).
Stent thrombosis developed in 3.2% (1/31) of DAPT patients, 6.5% (3/46) of AA patients, and 1.9% (1/52) of TT patients (P = 0.32).

Structured PICO

Do different antiplatelet and anticoagulation regimens affect bleeding and ischemic outcomes in patients with atrial fibrillation undergoing carotid artery stenting?

P

Population

129 patients with pre-existing atrial fibrillation who underwent carotid artery stenting (CAS) from 2011 to 2024

I

Intervention

Single antiplatelet therapy plus oral anticoagulation (AA) or triple therapy (dual antiplatelet therapy plus oral anticoagulation, TT)

C

Comparator

Dual antiplatelet therapy (DAPT)

O

Outcome

Incidence of major bleedingsafety

Implication

In patients with atrial fibrillation undergoing carotid artery stenting, there were no significant differences in bleeding or ischemic outcomes at 3 months among dual antiplatelet therapy, single antiplatelet plus anticoagulation, or triple therapy.

Abstract

Introduction There is no consensus on the optimal secondary stroke prevention regimen for patients with atrial fibrillation undergoing carotid artery stenting (CAS). Our objective is to compare the long-term efficacy and safety of different medical regimens after CAS. Methods This retrospective observational study included patients with pre-existing atrial fibrillation who underwent CAS from 2011 to 2024. Patients were divided into three treatment groups: dual antiplatelet therapy (DAPT), single antiplatelet therapy plus oral anticoagulation (AA), and triple therapy (dual antiplatelet therapy plus oral anticoagulation, TT). The primary outcome was the incidence of major bleeding. Secondary outcomes included the incidence of clinically relevant minor bleeding, recurrent stroke, and stent thrombosis. Results Of the 1047 patients who underwent CAS, 129 met the inclusion criteria: 31 in the DAPT group, 46 in the AA group, and 52 in the TT group. At 3 months, major bleeding events occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 7.7% (4/52) in the TT group ( P = 0.71). Ischemic stroke after stent placement occurred in 6.4% (2/31) of cases in the DAPT group, compared to 4.3% (2/46) in the AA group and 1.9% (1/52) in the TT group ( P = 0.57). Stent thrombosis occurred in 3.2% (1/31) of patients in the DAPT group, 6.5% (3/46) in the AA group, and 1.9% (1/52) in the TT group ( P = 0.32). Conclusion Our findings suggest no significant differences in bleeding events or ischemic outcomes among the different antiplatelet and anticoagulation regimens in patients with atrial fibrillation who underwent CAS.