颈动脉支架植入术后3个月双重抗血小板治疗的安全性和有效性：回顾性倾向评分匹配分析。

IF 1.8 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2025-09-17 DOI:10.1016/j.jstrokecerebrovasdis.2025.108452

Manato Kishi MD Candidate , Taisuke Akimoto MD, PhD , So Ozaki MD , Yuta Otomo MD , Yu Iida MD , Takafumi Kawasaki MD, PhD , Shigeta Miyake MD, PhD , Masaki Sonoda MD, PhD , Satoshi Hori MD, PhD , Kotaro Oshio MD, PhD , Yasunobu Nakai MD, PhD , Katsumi Sakata MD, PhD , Tetsuya Yamamoto MD, PhD

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引用次数: 0

摘要

背景：颈动脉支架植入术（CAS）后双重抗血小板治疗（DAPT）的最佳持续时间尚不清楚。因此，本研究旨在比较四个中心采用不同DAPT策略（3个月和延长时间）的结果，以评估安全性和有效性。方法：我们回顾性评估了2010年至2022年间接受CAS治疗的347例患者。根据DAPT持续时间将患者分为3个月和3个月两组。我们比较了患者背景、术后卒中事件和dapt相关的出血并发症。进行倾向评分配对，并对80对配对进行分析。结果：在80对配对队列中，3个月DAPT组脑梗死和短暂性脑缺血发作发生率分别为4例和10例，3个月DAPT组脑梗死和短暂性脑缺血发作发生率分别为10例和10例。3个月组颅内出血2例，3个月组颅内出血7例，3个月组颅内出血7例。Log-rank检验显示，>3个月DAPT与出血并发症（包括颅内和颅外出血）的发生率有统计学意义（风险比[HR]: 6.21, 95%可信区间[CI] 1.23-31.4, p=0.014），而缺血事件发生率无统计学差异（风险比[HR] 2.90, 95% CI 0.89-9.46, p=0.077）。结论：在我们的一系列接受DAPT治疗的CAS患者中，与更长时间的DAPT治疗方案相比，在过渡到SAPT之前的3个月方案具有相似的疗效和更低的出血发生率。高危缺血性病例应单独考虑；然而，DAPT的常规延长可能没有必要超过3个月。

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Safety and efficacy of 3-month dual antiplatelet therapy after carotid artery stenting: A retrospective propensity score-matched analysis

Background

The optimal duration of dual antiplatelet therapy (DAPT) following carotid artery stenting (CAS) is unclear. Therefore, this study aimed to compare outcomes across four centers with differing DAPT strategies—3-month versus extended duration—to assess safety and efficacy.

Methods

We retrospectively evaluated 347 patients who underwent CAS between 2010 and 2022. Patients were categorized into two groups according to DAPT duration:3 months or >3 months. We compared patient backgrounds, postoperative stroke events, and DAPT-related hemorrhagic complications. Propensity score matching was performed, and 80 matched pairs were analyzed.

Results

In the matched cohort of 80 pairs, the incidence of ischemic events, including cerebral infarction and transient ischemic attack, was four and 10 in the 3-month DAPT and >3-month DAPT groups, respectively. Intracranial and extracranial hemorrhagic events occurred in two and seven cases in the 3-month and >3-month groups, respectively. Log-rank testing showed a statistically significant association between >3-month DAPT and higher incidence of hemorrhagic complications (including intracranial and extracranial hemorrhage) (hazard ratio [HR]: 6.21, 95 % confidence interval [CI] 1.23–31.4, p=0.014), whereas no significant difference was observed in ischemic event rates (HR 2.90, 95 % CI 0.89–9.46, p=0.077).

Conclusion

In our series of CAS patients treated with DAPT, a 3-month regimen before transitioning to SAPT was associated with similar efficacy and a lower incidence of hemorrhages compared to longer DAPT regimens. High-risk ischemic cases should be considered individually; however, routine extension of DAPT beyond 3 months may not be necessary.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.