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Research ArticleNeurointervention
Open Access

Antithrombotic Treatment after Carotid Stenting in Patients with Concomitant Atrial Fibrillation

B. Pardo-Galiana, M. Medina-Rodriguez, M. Millan-Vazquez, J.A. Cabezas-Rodriguez, L. Lebrato-Hernandez, L. Ainz-Gomez, E. Zapata-Arriaza, J. Ortega, A. de Albóniga-Chindurza, J. Montaner, A. Gonzalez and F. Moniche
American Journal of Neuroradiology April 2022, DOI: https://doi.org/10.3174/ajnr.A7482
B. Pardo-Galiana
aFrom the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., F.M.)
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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M. Medina-Rodriguez
aFrom the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., F.M.)
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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M. Millan-Vazquez
bNeurology Department (M.M.-V.)
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J.A. Cabezas-Rodriguez
aFrom the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., F.M.)
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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L. Lebrato-Hernandez
aFrom the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., F.M.)
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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L. Ainz-Gomez
aFrom the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., F.M.)
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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E. Zapata-Arriaza
cInterventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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J. Ortega
cInterventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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A. de Albóniga-Chindurza
cInterventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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J. Montaner
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
eStroke Unit (J.M.), Neurology Department, University Hospital Virgen Macarena, Seville, Spain
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A. Gonzalez
cInterventional Neuroradiology Unit (E.Z.-A., J.O., A.d.A.-C., A.G.), Radiology Department, University Hospital Virgen del Rocio, Seville, Spain
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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F. Moniche
aFrom the Stroke Unit (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., F.M.)
dNeurovascular Lab (B.P.-G., M.M.-R., J.A.C.-R., L. L.-H., L.A.-G., E.Z.-A., J.O., A.d.A.-C., J.M., A.G., F.M.), Biomedicine Institute of Seville, Seville, Spain
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    FIG 1.

    Antithrombotic strategy management. LMWH indicates low-molecular-weight heparin; VKA, vitamin K antagonist.

  • FIG 2.
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    FIG 2.

    Management recommendations in patients undergoing CAS with concomitant AF. Once CS (if suitable for CAS) is diagnosed, we recommend dual antiplatelet therapy (aspirin and clopidogrel) plus anticoagulation with a DOAC at least 5 days before CAS. Anticoagulation should be stopped 24 hours before CAS and re-initiated 24 hours after. According to antiplatelet therapy after CAS, we recommend a regimen including DOAC plus clopidogrel during the first month after CAS and then switching clopidogrel to aspirin.

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    Table 1:

    Baseline characteristics

    Total (n = 91)DC Group (n = 24)TT Group(n = 42)DAPT Group (n = 25)P
    Age (mean) (SD) (yr)72.27 (SD, 8.1)72.4 (SD, 6.7)72.6 (SD, 9)71.6 (SD, 8.3).9
    Female sex (No.) (%)16 (17.6)6 (25)8 (19)2 (8).119
    CHAsDS2-VASc score (mean)5.3 (SD, 1.3)5.5 (SD, 1.1)5.1 (SD, 1.4)5.3 (SD, 1.4).548
    HAS-BLED score (mean)3.9 (SD, 0.9)3.8 (SD, 0.6)3.8 (SD, 0.9)4.24 (SD, 0.9).168
    Hypertension (No.) (%)79 (86.8)22 (91.7)35 (83.3)22 (88).616
    Diabetes mellitus (No.) (%)44 (48.4)14 (58.3)15 (35.7)15 (60).082
    Dyslipidemia (No.) (%)68 (74.7)20 (83.3)31 (73.8)17 (68).459
    Heart failure (No.) (%)41 (45.1)14 (58.3)17 (40.5)10 (40).313
    Smoker (No.) (%)23 (25.27)6 (25)7 (16.7)10 (40).1
    Peripheral arteriopathy (No.) (%)18 (18.5)3 (12.5)6 (25)9 (0.36).57
    Serum creatinine levels (No.) (%)
    <1.5 mg/dL79 (86.8)19 (79.2)40 (95.2)20 (80).956
    ≥1.5 mg/d2 (13.2)5 (20.8)2 (4.8)5 (20)
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    Table 2:

    Safety and efficacy outcomes

    DC GroupTT GroupDAPT GroupP
    Major or clinically relevant nonmajor bleeding (No.) (%)010 (23.8)1 (4).006
    Major bleeding (No.) (%)04 (9.5)0.138
    Efficacy outcome
     Stroke (No.) (%)001 (4).41
     Stent thrombosis (No.) (%)1 (4.1)00
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B. Pardo-Galiana, M. Medina-Rodriguez, M. Millan-Vazquez, J.A. Cabezas-Rodriguez, L. Lebrato-Hernandez, L. Ainz-Gomez, E. Zapata-Arriaza, J. Ortega, A. de Albóniga-Chindurza, J. Montaner, A. Gonzalez, F. Moniche
Antithrombotic Treatment after Carotid Stenting in Patients with Concomitant Atrial Fibrillation
American Journal of Neuroradiology Apr 2022, DOI: 10.3174/ajnr.A7482

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Antithrombotic Treatment after Carotid Stenting in Patients with Concomitant Atrial Fibrillation
B. Pardo-Galiana, M. Medina-Rodriguez, M. Millan-Vazquez, J.A. Cabezas-Rodriguez, L. Lebrato-Hernandez, L. Ainz-Gomez, E. Zapata-Arriaza, J. Ortega, A. de Albóniga-Chindurza, J. Montaner, A. Gonzalez, F. Moniche
American Journal of Neuroradiology Apr 2022, DOI: 10.3174/ajnr.A7482
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