The Influence of Anti-Platelet Resistance on the Development of Cerebral Ischemic Lesion after Carotid Artery Stenting
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Purpose: Cerebral ischemic lesions are frequently observed after carotid artery stenting (CAS), and anti-platelet agents are used to prevent stent thrombosis and peri-procedural complications. However, despite the premedication, cerebral ischemic lesions are observed, suggesting that they may rather be related to anti-platelet resistance. We, therefore, investigated the effects of anti-platelet resistance on the development of cerebral ischemic lesions after CAS. Materials and Methods: We retrospectively reviewed patients who received CAS and selected patients for whom brain MRI was performed within 24 hours after CAS and for whom anti-platelet resistance was checked. Anti-platelet resistance was examined by the VerifyNow system. We analyzed the correlation between anti-platelet resistance and cerebral ischemic lesions detected on follow-up MRI. Results: Among 76 patients,45 (59.2%) developed new ischemic lesions after CAS. Twelve (15.8%) patients showed aspirin resistance and 50 (65.8%) patients showed clopidogrel resistance. Patients with a new ischemic lesion demonstrated a significantly greater frequency of clopidogrel resistance than those who had no new ischemic lesion (82.2% versus 41.9%, p=0.001). The frequency of aspirin resistance was not significantly different between the groups of patients with and without new ischemic lesions (20.0% versus 9.7%, p=0.340). In multivariate analysis, clopidogrel resistance was a significant risk factor for post-procedural cerebral ischemia. Conclusion:Anti-platelet resistance can be used to predict new ischemic lesions after CAS. Anti-platelet resistance should be evaluated in all patients prior to CAS to prevent ischemic complications related to CAS.
Abstract
Purpose: Cerebral ischemic lesions are frequently observed after carotid artery stenting (CAS), and anti-platelet agents are used to prevent stent thrombosis and peri-procedural complications. However, despite the premedication, cerebral ischemic lesions are observed, suggesting that they may rather be related to anti-platelet resistance. We, therefore, investigated the effects of anti-platelet resistance on the development of cerebral ischemic lesions after CAS. Materials and Methods: We retrospectively reviewed patients who received CAS and selected patients for whom brain MRI was performed within 24 hours after CAS and for whom anti-platelet resistance was checked. Anti-platelet resistance was examined by the VerifyNow system. We analyzed the correlation between anti-platelet resistance and cerebral ischemic lesions detected on follow-up MRI. Results: Among 76 patients,45 (59.2%) developed new ischemic lesions after CAS. Twelve (15.8%) patients showed aspirin resistance and 50 (65.8%) patients showed clopidogrel resistance. Patients with a new ischemic lesion demonstrated a significantly greater frequency of clopidogrel resistance than those who had no new ischemic lesion (82.2% versus 41.9%, p=0.001). The frequency of aspirin resistance was not significantly different between the groups of patients with and without new ischemic lesions (20.0% versus 9.7%, p=0.340). In multivariate analysis, clopidogrel resistance was a significant risk factor for post-procedural cerebral ischemia. Conclusion:Anti-platelet resistance can be used to predict new ischemic lesions after CAS. Anti-platelet resistance should be evaluated in all patients prior to CAS to prevent ischemic complications related to CAS.
참고문헌 (30)
- Poppert H, "Differences in number, size and location of intracranial microembolic lesions after surgical versus endovascular treatment without protection device of carotid artery stenosis", J Neurol, 251, pp.1198~1203 (2004)
- Hammer FD, "Cerebral microembolization after protected carotid artery stenting in surgical high-risk patients: results of a 2-year prospective study", J Vasc Surg, 42, pp.847~853 (2005)
- European Stroke Initiative Executive Committee, "European Stroke Initiative Recommendations for Stroke Management-update 2003", Cerebrovasc Dis, 16, pp.311~337 (2003)
- Gossetti B, "Embolism to the brain during carotid stenting and surgery", Acta Chir Belg, 107, pp.151~154 (2007)
- Schlüter M, "Focal ischemia of the brain after neuroprotected carotid artery stenting", J Am Coll Cardiol, 42, pp.1007~1013 (2003)
- Hauth EA, "MR and clinical follow-up of diffusion-weighted cerebral lesions after carotid artery stenting", AJNR Am J Neuroradiol, 26, pp.2336~2341 (2005)
- Angiolillo DJ, "Identification of low responders to a 300-mg clopidogrel loading dose in patients undergoing coronary stenting", Thromb Res, 115, pp.101~108 (2005)
- Marcucci R, "Usefulness of aspirin resistance after percutaneous coronary intervention for acute myocardial infarction in predicting one-year major adverse coronary events", Am J Cardiol, 98, pp.1156~1159 (2006)
- Matetzky S, "Clopidogrel resistance is associated with increased risk of recurrent atherothrombotic events in patients with acute myocardial infarction", Circulation, 109, pp.3171~3175 (2004)
- Prabhakaran S, "Prevalence and risk factors for aspirin and clopidogrel resistance in cerebrovascular stenting", AJNR Am J Neuroradiol, 29, pp.281~285 (2008)
- Reavey-Cantwell JF, "Factors associated with aspirin resistance in patients premedicated with aspirin and clopidogrel for endovascular neurosurgery", Neurosurgery, 64, pp.890~895 (2009)
- Lee DH, "Dual antiplatelet therapy monitoring for neurointerventional procedures using a point-of-care platelet function test: a single-center experience", AJNR Am J Neuroradiol, 29, pp.1389~1394 (2008)
- Montorsi P, "Randomized trial of predilation versus direct stenting for treatment of carotid artery stenosis", Int J Cardiol, 138, pp.233~238 (2010)
- Jaeger HJ, "Cerebral ischemia detected with diffusion-weighted MR imaging after stent implantation in the carotid artery", AJNR Am J Neuroradiol, 23, pp.200~207 (2002)
- Patti G, "Point-of-care measurement of clopidogrel responsiveness predicts clinical outcome in patients undergoing percutaneous coronary intervention results of the ARMYDA-PRO (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-Platelet Reactivity Predicts Outcome) study", J Am Coll Cardiol, 52, pp.1128~1133 (2008)
- Mangiacapra F, "Comparison of platelet reactivity and periprocedural outcomes in patients with versus without diabetes mellitus and treated with clopidogrel and percutaneous coronary intervention", Am J Cardiol, 106, pp.619~623 (2010)
- Piñero P, "Volume and composition of emboli in neuroprotected stenting of the carotid artery", AJNR Am J Neuroradiol, 30, pp.473~478 (2009)
- Krasopoulos G, "Aspirin “resistance” and risk of cardiovascular morbidity: systematic review and meta-analysis", BMJ, 336, pp.195~198 (2008)
- Müller I, "Prevalence of clopidogrel non-responders among patients with stable angina pectoris scheduled for elective coronary stent placement", Thromb Haemost, 89, pp.783~787 (2003)
- Oqueli E, "Clopidogrel resistance", Heart Lung Circ, 16(3), pp.S17~S28 (2007)
- Wang TH, "Aspirin and clopidogrel resistance: an emerging clinical entity", Eur Heart J, 27, pp.647~654 (2006)
- Lev EI, "Aspirin and clopidogrel drug response in patients undergoing percutaneous coronary intervention: the role of dual drug resistance", J Am Coll Cardiol, 47, pp.27~33 (2006)
- McDonnell CO, "Value of diffusion-weighted MRI during carotid angioplasty and stenting", Eur J Vasc Endovasc Surg, 32, pp.46~50 (2006)
- Warach S, "Acute human stroke studied by whole brain echo planar diffusion-weighted magnetic resonance imaging", Ann Neurol, 37, pp.231~241 (1995)
- Fiebach JB, "CT and diffusion-weighted MR imaging in randomized order: diffusion-weighted imaging results in higher accuracy and lower interrater variability in the diagnosis of hyperacute ischemic stroke", Stroke, 33, pp.2206~2210 (2002)
- du Mesnil de Rochemont R, "Diffusion-weighted MR imaging lesions after filter-protected stenting of high-grade symptomatic carotid artery stenoses", AJNR Am J Neuroradiol, 27, pp.1321~1325 (2006)
- Jaeger HJ, "Diffusion-weighted MR imaging after angioplasty or angioplasty plus stenting of arteries supplying the brain", AJNR Am J Neuroradiol, 22, pp.1251~1259 (2001)
- Piñero P, "Silent ischemia after neuroprotected percutaneous carotid stenting: a diffusion-weighted MRI study", AJNR Am J Neuroradiol, 27, pp.1338~1345 (2006)
- Palombo G, "Late evaluation of silent cerebral ischemia detected by diffusion-weighted MR imaging after filter-protected carotid artery stenting", AJNR Am J Neuroradiol, 29, pp.1340~1343 (2008)
- Seung-Yeob Lee, "Higher Lesion Detection by 3.0T MRI in Patient with Transient Global Amnesia", Yonsei Medical Journal, 50(2), pp.211~214 (2009), 연세대학교의과대학