Safety of Dual Antiplatelet Therapy After Carotid Endarterectomy for Prevention of Restenosis: A Single Center Experience.
BACKGROUND
The incidence of recurrent carotid stenosis after carotid endarterectomy varies from 1% to 37% with only 0-8% symptomatic restenosis. Safety of short-term (30 days) dual-antiplatelet therapy has not been established in this type of procedure.


OBJECTIVE
To investigate the safety of dual antiplatelet therapy after carotid endarterectomy to prevent restenosis.


METHODS
We retrospectively identified all the patients who underwent carotid endarterectomy (symptomatic or asymptomatic) treated at our center between July 2010 and July 2013 according to local protocols. All patients received a dose of 100 mg of aspirin daily immediately after carotid endarterectomy, with subsequent 100 mg of aspirin daily for the rest of the study period, and some patients received 75 mg of Clopidogrel for 30 days starting immediately after surgical procedure (dual therapy group), assigned according to medical criteria. Duplex carotid ultrasound and clinical assessments were performed at 30 days and 1 year after the procedure.


RESULTS
A total of 44 patients (71.2 ± 7.9 years old; 77.2% symptomatic) were analyzed; 35 of them with dual therapy (79.54%). At 30 days, two patients from the mono-therapy group developed restenosis (22.2%), compared to none in dual therapy group (p=0.04). At one year follow-up, only one patient from the dual group showed restenosis (p=0.10). No deaths, major bleeding or new strokes were reported in both groups.


CONCLUSIONS
Short-term dual antiplatelet therapy with aspirin and clopidogrel after carotid endarterectomy might be associated with a lower incidence of restenosis. This observation must be validated in a prospective trial.
Miguel A
MA
Barboza
José
J
Chang
Alvaro
A
Hernández
Emmanuel
E
Martínez
Huberth
H
Fernández
Gerardo
G
Quirós
Johanna
J
Salazar
Allan
A
Ramos-Esquivel
Alberto
A
Maud
atherosclerotic carotid disease; carotid endarterectomy; cerebrovascular disease; dual antiplatelet therapy