Carotid stenting can be an alternative to carotid endarterectomy in patients with recent symptomatic carotid artery disease. Periprocedural complications can be significantly reduced with a dual antiplatelet regime that includes clopidogrel. Clopidogrel has been shown to vary in its antiplatelet effectiveness. The effect of this response was studied during stenting procedures using platelet function tests and transcranial Doppler detected emboli counts in the perioperative period.
Methods Whole blood single platelet counting assessed ADP induced platelet aggregation. Patients were classified as responders, semi responders and nonresponders to clopidogrel on these results. Recordings from the middle cerebral artery ipsilateral to the carotid being stented were analysed offline for embolic events preoperative and immediately postoperative.
Results 28 patients were included in the study. In the 1 h postoperative recording mean emboli counts were not shown to be statistically different between the groups. (p=0.76). One patient later shown to be a nonresponder had significant numbers of emboli (Abstract POS10 Figure 1).
Discussion Minor differences in clopidogrel induced platelet inhibition in patients undergoing carotid stenting do not appear to effect transcranial Doppler based emboli counts around the time of carotid stenting. This is likely due to the multifactorial nature of complications from stenting.
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