The benefits of combined anti-platelet treatment in carotid artery stenting

Objective. To assess the benefits of a combined anti-platelet regime of aspirin and clopidogrel in carotid artery stenting. Methods. A randomised controlled trial was performed comparing aspirin and 24-h heparin with aspirin and clopidogrel for patients undergoing carotid artery stenting. Outcome measures included 30-day bleeding and neurological complications and 30-day stenosis rates. Results. Bleeding complications (groin haematoma or excessive bleeding at the groin site) occurred in 17% of the heparin and 9% of the clopidogrel group (p = 0.35; n.s). The neurological complication rate in the 24-h heparin group was 25% compared to 0% in the clopidogrel group (p = 0.02). The 30-day 50-100% stenosis rates were 26% in the heparin group and 5% in the clopidogrel group (p = 0.10; n.s). Conclusions. The dual anti-platelet regime has a significant impact on reducing adverse neurological outcomes without an additional increase in bleeding complications. This study was terminated prematurely due to an unacceptable level of complications in the heparin arm of the trial.