Clopidogrel Resistance Is Common in Patients Undergoing Vascular and Coronary Interventions

Abstract

were queried for carotid stenting procedures (CAS). Emergent and bilateral procedures, patients with prior ipsilateral CAS, ICA lesions with stenosis of <50%, and hybrid transcarotid procedures were excluded. The cohort was stratified by symptomatic status. The primary outcome was the composite of perioperative neurologic events and death. Predictors of stroke/death were determined with multivariable logistic regression for symptomatic and asymptomatic patients with tandem lesions forced into the models.Results: There were 18,886 carotid arteries stented (18,441 patients); 18,077 (96%) with isolated lesions, 809 (4%) with tandem lesions. The mean age was 70.0 6 9.7 years. Symptomatic lesions were present in 58.9% of cases (isolated, 59.1% vs tandem, 52.5%; P < .001). More tandem group arteries had a prior carotid endarterectomy (38.3% vs 23.8%; P < .001). Neuroprotection was more likely to be successfully deployed with isolated lesions (94.7% vs 91.1%; P < .001). Tandem lesions had a higher perioperative stroke/death (4.7% vs 2.5%; P ¼ .007) for asymptomatic lesions, but not symptomatic lesions (5.4% vs 5.3%; P ¼ .92). Tandem lesions were independently associated with stroke/death in asymptomatic patients (odds ratio, 1.91; 95% confidence interval, 1.16-3.16; P ¼ .012) but not symptomatic patients (Table ).Conclusions: The addition of endovascular treatment of tandem CCA lesions with CAS is associated with almost double the risk of perioperative stroke/death in asymptomatic patients and should be avoided if possible. Treatment of tandem lesions is not associated with an increased risk of stroke/death for symptomatic lesions.