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The Influence of Anti-Platelet Resistance on the Development of Cerebral Ischemic Lesion after Carotid Artery Stenting

 Tae-Jin Song  ;  Sang Hyun Suh  ;  Pil-Ki Min  ;  Dong Joon Kim  ;  Byung Moon Kim  ;  Ji Hoe Heo  ;  Young-Dae Kim  ;  Kyung-Yul Lee 
 YONSEI MEDICAL JOURNAL, Vol.54(2) : 288-294, 2013 
Journal Title
Issue Date
Aged ; Aspirin/therapeutic use* ; Brain Ischemia/diagnosis ; Brain Ischemia/etiology* ; Carotid Arteries/surgery* ; Drug Resistance* ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Platelet Aggregation Inhibitors/therapeutic use* ; Retrospective Studies ; Stents/adverse effects*
Cerebral infarction ; aspirin resistance ; clopidogrel resistance ; carotid artery stent
PURPOSE: Cerebral ischemic lesions are frequently observed after carotid artery stenting (CAS), and anti-platelet agents are used to prevent stent thrombosis and peri-procedural complications. However, despite the premedication, cerebral ischemic lesions are observed, suggesting that they may rather be related to anti-platelet resistance. We, therefore, investigated the effects of anti-platelet resistance on the development of cerebral ischemic lesions after CAS. MATERIALS AND METHODS: We retrospectively reviewed patients who received CAS and selected patients for whom brain MRI was performed within 24 hours after CAS and for whom anti-platelet resistance was checked. Anti-platelet resistance was examined by the VerifyNow system. We analyzed the correlation between anti-platelet resistance and cerebral ischemic lesions detected on follow-up MRI. RESULTS: Among 76 patients, 45 (59.2%) developed new ischemic lesions after CAS. Twelve (15.8%) patients showed aspirin resistance and 50 (65.8%) patients showed clopidogrel resistance. Patients with a new ischemic lesion demonstrated a significantly greater frequency of clopidogrel resistance than those who had no new ischemic lesion (82.2% versus 41.9%, p=0.001). The frequency of aspirin resistance was not significantly different between the groups of patients with and without new ischemic lesions (20.0% versus 9.7%, p=0.340). In multivariate analysis, clopidogrel resistance was a significant risk factor for post-procedural cerebral ischemia. CONCLUSION: Anti-platelet resistance can be used to predict new ischemic lesions after CAS. Anti-platelet resistance should be evaluated in all patients prior to CAS to prevent ischemic complications related to CAS.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Min, Pil Ki(민필기) ORCID logo https://orcid.org/0000-0001-7033-7651
Suh, Sang Hyun(서상현) ORCID logo https://orcid.org/0000-0002-7098-4901
Song, Tae Jin(송태진)
Lee, Kyung Yul(이경열) ORCID logo https://orcid.org/0000-0001-5585-7739
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
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