title: Clopidogrel use before renal artery angioplasty with/without stent placement resulted in tertiary procedure risk reduction.
abstract: OBJECTIVE
  Contrary to coronary artery literature, the effect of preprocedural clopidogrel on renal artery restenosis (RAR) has not been characterized. This study was designed to evaluate the effect of preprocedural clopidogrel on target vessel revascularization (TVR), reintervention, and restenosis for patients who underwent recurrent renal artery angioplasty.
  
  
  METHODS
  A retrospective analysis of patients treated for RAR in a single tertiary center from January 1999 to December 2009 was conducted. Patients were divided into preadmission use of (1) clopidogrel or (2) aspirin only (acetylsalicylic acid [ASA]) for the initial procedure. TVR was defined as occurrence of a tertiary procedure for symptomatic RAR. Rate of freedom from event (ie, tertiary restenosis and TVR) was analyzed using Kaplan-Meier method.
  
  
  RESULTS
  Eighty-eight interventions were performed on 77 patients with RAR; 66% were females with average (mean ± SEM) age and body mass index of 68.8 ± 1.1 and 28.6 ± 0.8, respectively. Comorbidities included 96% chronic hypertension, 33% diabetes, 76% hyperlipidemia, 20% renal insufficiency, 39% tobacco use, 58% coronary artery disease, and 51% peripheral vascular disease. Clopidogrel use increased significantly during the index procedure from admission 35.2% to discharge 97.7% (P < .001, McNemar test). There was a trend toward risk reduction of a tertiary intervention (23%) for patients admitted on clopidogrel compared with ASA (P = .052). Likewise, there was a trend (P = .051) toward increased freedom from a tertiary intervention, with cumulative freedom at 8 years 93.5% for clopidogrel vs 61% for ASA. No differences were found for restenosis.
  
  
  CONCLUSIONS
  The use of preprocedural clopidogrel was associated with a possible risk reduction of TVR reintervention, but this finding needs to be validated in randomized clinical trial.
authors.affiliation: Department of Surgery, Robert C. Byrd Health Sciences Center, West Virginia University, Charleston, WV 25304, USA. amousa@hsc.wvu.edu
authors.forename: Albeir Y
authors.initials: AY
authors.lastname: Mousa
authors.forename: Mike
authors.initials: M
authors.lastname: Broce
authors.forename: John
authors.initials: J
authors.lastname: Campbell
authors.forename: Aravinda
authors.initials: A
authors.lastname: Nanjundappa
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Stone
authors.forename: Shadi
authors.initials: S
authors.lastname: Abu-Halimah
authors.forename: Mohit
authors.initials: M
authors.lastname: Srivastava
authors.forename: Mark C
authors.initials: MC
authors.lastname: Bates
authors.forename: Ali F
authors.initials: AF
authors.lastname: Aburahma
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D001241:Aspirin / Q000627:therapeutic use; D000077144:Clopidogrel; D015897:Comorbidity; D005260:Female; D006801:Humans; D015993:Life Tables; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D012078:Renal Artery Obstruction / Q000453:epidemiology / Q000628:therapy*; D019233:Retreatment; D055502:Secondary Prevention; D015607:Stents; D013988:Ticlopidine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin