Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy

Carotid endarterectomy is usually preferred over carotid artery stenting (CAS) for patients with atrial fibrillation (AF). We present our experience with short-course periprocedural triple antithrombotic therapy in 32 patients aged >18 years with nonvalvular AF undergoing CAS. There were no death...

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Autores principales:	José E. Cohen, John Moshe Gomori, Asaf Honig, Ronen R. Leker
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	anticoagulation antiplatet regimen atrial fibrillation carotid artery stenting carotid stenosis ischemic stroke Medicine R
Acceso en línea:	https://doaj.org/article/65fed6d504b142a28770459d3c3e0f81
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spelling	oai:doaj.org-article:65fed6d504b142a28770459d3c3e0f812021-11-25T18:00:49ZCarotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy10.3390/jcm102252422077-0383https://doaj.org/article/65fed6d504b142a28770459d3c3e0f812021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5242https://doaj.org/toc/2077-0383Carotid endarterectomy is usually preferred over carotid artery stenting (CAS) for patients with atrial fibrillation (AF). We present our experience with short-course periprocedural triple antithrombotic therapy in 32 patients aged >18 years with nonvalvular AF undergoing CAS. There were no deaths, cardiac events, embolic strokes, hyperperfusion syndrome, intracranial hemorrhage, or stent thrombosis within 30 days. Transient intraprocedural hemodynamic instability in 15/32 (47%) and prolonged instability in 4/32 (13%) was managed conservatively. At a mean 16-month follow-up, there were no new neurological events or deterioration. Mean stenosis was reduced from 78.0% ± 9.7% to 17.3% ± 12.2%. This retrospective study included patients AF who were symptomatic (minor stroke (NIHSS ≤ 5)/TIA) with ICA stenosis >50%, or asymptomatic under DOAC therapy with carotid stenosis >80%, who underwent CAS from 6/2014–10/2020. Patients received double antiplatelets and statins. Antiplatelet therapy effectiveness was monitored. Stenting was performed when P2Y12 reaction units (PRU) were <150. DOACs were discontinued 48 h before angioplasty; one 60 mg dose of subcutaneous enoxaparin was administered in lieu. DOAC was restarted 12–24 h after intervention. Patients were discharged under DOAC and one nonaspirin antiplatelet. 32 patients on DOAC were included (26 male, mean age 71). 19 (59.4%) presented with stroke (ICA stenosis-related in 14); 13 (40.6%) were asymptomatic. Stents were deployed under filter protection following pre-angioplasty; post-angioplasty was performed at least once in 12 patients (37.5%). Our experience suggests that CAS can be safely performed in selected patients with CAS and AF requiring DOAC. The role of CAS in AF patients under DOAC warrants study in rigorous trials.José E. CohenJohn Moshe GomoriAsaf HonigRonen R. LekerMDPI AGarticleanticoagulationantiplatet regimenatrial fibrillationcarotid artery stentingcarotid stenosisischemic strokeMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5242, p 5242 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	anticoagulation antiplatet regimen atrial fibrillation carotid artery stenting carotid stenosis ischemic stroke Medicine R
spellingShingle	anticoagulation antiplatet regimen atrial fibrillation carotid artery stenting carotid stenosis ischemic stroke Medicine R José E. Cohen John Moshe Gomori Asaf Honig Ronen R. Leker Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy
description	Carotid endarterectomy is usually preferred over carotid artery stenting (CAS) for patients with atrial fibrillation (AF). We present our experience with short-course periprocedural triple antithrombotic therapy in 32 patients aged >18 years with nonvalvular AF undergoing CAS. There were no deaths, cardiac events, embolic strokes, hyperperfusion syndrome, intracranial hemorrhage, or stent thrombosis within 30 days. Transient intraprocedural hemodynamic instability in 15/32 (47%) and prolonged instability in 4/32 (13%) was managed conservatively. At a mean 16-month follow-up, there were no new neurological events or deterioration. Mean stenosis was reduced from 78.0% ± 9.7% to 17.3% ± 12.2%. This retrospective study included patients AF who were symptomatic (minor stroke (NIHSS ≤ 5)/TIA) with ICA stenosis >50%, or asymptomatic under DOAC therapy with carotid stenosis >80%, who underwent CAS from 6/2014–10/2020. Patients received double antiplatelets and statins. Antiplatelet therapy effectiveness was monitored. Stenting was performed when P2Y12 reaction units (PRU) were <150. DOACs were discontinued 48 h before angioplasty; one 60 mg dose of subcutaneous enoxaparin was administered in lieu. DOAC was restarted 12–24 h after intervention. Patients were discharged under DOAC and one nonaspirin antiplatelet. 32 patients on DOAC were included (26 male, mean age 71). 19 (59.4%) presented with stroke (ICA stenosis-related in 14); 13 (40.6%) were asymptomatic. Stents were deployed under filter protection following pre-angioplasty; post-angioplasty was performed at least once in 12 patients (37.5%). Our experience suggests that CAS can be safely performed in selected patients with CAS and AF requiring DOAC. The role of CAS in AF patients under DOAC warrants study in rigorous trials.
format	article
author	José E. Cohen John Moshe Gomori Asaf Honig Ronen R. Leker
author_facet	José E. Cohen John Moshe Gomori Asaf Honig Ronen R. Leker
author_sort	José E. Cohen
title	Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy
title_short	Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy
title_full	Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy
title_fullStr	Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy
title_full_unstemmed	Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy
title_sort	carotid artery stenting in patients with atrial fibrillation: direct oral anticoagulants, brief double antiplatelets, and testing strategy
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/65fed6d504b142a28770459d3c3e0f81
work_keys_str_mv	AT joseecohen carotidarterystentinginpatientswithatrialfibrillationdirectoralanticoagulantsbriefdoubleantiplateletsandtestingstrategy AT johnmoshegomori carotidarterystentinginpatientswithatrialfibrillationdirectoralanticoagulantsbriefdoubleantiplateletsandtestingstrategy AT asafhonig carotidarterystentinginpatientswithatrialfibrillationdirectoralanticoagulantsbriefdoubleantiplateletsandtestingstrategy AT ronenrleker carotidarterystentinginpatientswithatrialfibrillationdirectoralanticoagulantsbriefdoubleantiplateletsandtestingstrategy
_version_	1718411747173335040

Carotid Artery Stenting in Patients with Atrial Fibrillation: Direct Oral Anticoagulants, Brief Double Antiplatelets, and Testing Strategy

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