title: Strategies of clopidogrel load and atorvastatin reload to prevent ischemic cerebral events in patients undergoing protected carotid stenting. Results of the randomized ARMYDA-9 CAROTID (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting) study.
abstract: OBJECTIVE
  This study sought to evaluate whether a strategy with a 600-mg clopidogrel load and a short-term, high-dose atorvastatin reload would improve outcomes in clopidogrel-naïve, statin-treated patients undergoing protected carotid stenting.
  
  
  BACKGROUND
  Optimal clopidogrel loading dose during carotid stenting has not been investigated; in addition, statin neuroprotection in this setting has not been described.
  
  
  METHODS
  A total of 156 patients were randomized using a 2 × 2 factorial design to receive either a 600-mg (n = 78) or 300-mg (n = 78) clopidogrel load given 6 h before intervention and either a atorvastatin reload (n = 76; 80 mg + 40 mg initiating 12 h before the procedure) or no statin reload (n = 80). The primary endpoint was the 30-day incidence of transient ischemic attack/stroke or new ischemic lesions on cerebral diffusion-weighted magnetic resonance imaging performed at 24 to 48 h.
  
  
  RESULTS
  Occurrence of the primary outcome measure was significantly lower in the 600-mg clopidogrel arm (18% vs. 35.9% in the 300-mg group; p = 0.019) and in the atorvastatin reload arm (18.4% vs. 35.0% in the no statin reload group; p = 0.031). High-dose clopidogrel also significantly reduced the transient ischemic attack/stroke rate at 30 days (0% vs. 9%, p = 0.02, secondary endpoint), without an increase in bleeding risk.
  
  
  CONCLUSIONS
  In patients undergoing carotid stenting, a strategy using both a 600-mg clopidogrel load and a short-term reload with high-dose atorvastatin protects against early ischemic cerebral events. These results, obtained along with routine mechanical neuroprotection, provide new evidence of the optimization of drug therapy before percutaneous carotid intervention. (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting [ARMYDA-9 CAROTID]; NCT01572623).
authors.affiliation: Campus Bio-Medico University of Rome, Rome, Italy. g.patti@unicampus.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Patti
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Tomai
authors.forename: Rosetta
authors.initials: R
authors.lastname: Melfi
authors.forename: Elisabetta
authors.initials: E
authors.lastname: Ricottini
authors.forename: Michele
authors.initials: M
authors.lastname: Macrì
authors.forename: Pietro
authors.initials: P
authors.lastname: Sedati
authors.forename: Arianna
authors.initials: A
authors.lastname: Giardina
authors.forename: Cristina
authors.initials: C
authors.lastname: Aurigemma
authors.forename: Mario
authors.initials: M
authors.lastname: Leporace
authors.forename: Andrea
authors.initials: A
authors.lastname: D'Ambrosio
authors.forename: Germano
authors.initials: G
authors.lastname: Di Sciascio
mesh_terms: D000368:Aged; D000800:Angioplasty, Balloon; D000924:Anticholesteremic Agents / Q000008:administration & dosage*; D000069059:Atorvastatin; D002545:Brain Ischemia / Q000209:etiology / Q000517:prevention & control*; D002340:Carotid Artery Diseases / Q000150:complications / Q000628:therapy*; D016893:Carotid Stenosis; D000077144:Clopidogrel; D038524:Diffusion Magnetic Resonance Imaging; D004359:Drug Therapy, Combination; D005260:Female; D006538:Heptanoic Acids / Q000008:administration & dosage*; D006801:Humans; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage*; D011758:Pyrroles / Q000008:administration & dosage*; D012107:Research Design; D015607:Stents; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*; D016896:Treatment Outcome
chemical_list: D000924:Anticholesteremic Agents; D006538:Heptanoic Acids; D010975:Platelet Aggregation Inhibitors; D011758:Pyrroles; D000069059:Atorvastatin; D000077144:Clopidogrel; D013988:Ticlopidine