Abstract Background and aims Dual antiplatelet therapy is standard in carotid artery stenting (CAS), but clopidogrel resistance affects approximately 30-50% of patients. The aim of our study was to investigate whether pharmacodynamic testing-guided antiplatelet therapy improves outcomes in CAS. Methods All patients received preprocedural dual antiplatelet therapy with clopidogrel and acetylsalicylic acid. Prior to the procedure they underwent platelet function testing (VerifyNow) to assess clopidogrel resistance. In non-responders, clopidogrel was replaced with ticagrelor. Participants were monitored for the detection of newly developed focal neurological deficits as well as for potential puncture site complications. For the detection of asymptomatic ischemic lesions, all patients underwent brain MRI (DWI sequences) within 24 hours before and after CAS. Ultrasound assessment of the implanted CAS was done at 24 hours, one and three months after the procedure for the detection of restenosis. Results We analyzed the data for 50 study patients divided in clopidogrel (n=30) and ticagrelor (n=20) group. There was no difference in age or associated stroke risk factors between the two groups. Within ticagrelor group, a total of 47.6% were females, while in clopidogrel group only 19.4% (p=0.038). This finding could suggest that women more often required a switch from clopidogrel to ticagrelor, potentially reflecting sex-related differences in response to clopidogrel. There was no difference in MRI-DWI lesion count or in-stent stenosis between the two groups. Complications, although rare, also showed similar distribution. Conclusions Clopidogrel and ticagrelor showed similar effectivenes and safety profiles in our study when applied according to the results of clopidogrel resistance check. Conflict of interest Danira Bažadona: nothing to disclose. Nikola Blažević: nothing to disclose. Danilo Gardijan: nothing to disclose. Zdravka Poljaković: nothing to disclose.
Bažadona et al. (2026) studied this question.