Glycoprotein IIb/IIIa Antagonists During Carotid Artery Stenting: Results From the Carotid Artery Stenting (CAS) Registry of the Arbeitsgemeinschaft Leitende Kardiologische Krankenhausärzte (ALKK)

Clin Res Cardiol. 2007 Oct;96(10):730-7. doi: 10.1007/s00392-007-0551-7. Epub 2007 Jun 27.

Abstract

Background: Glycoprotein II b/IIIa antagonists (GPII b/IIIa-A) lower the periprocedural rate of ischemic events during high risk percutaneous coronary interventions. Their clinical impact on carotid artery stenting (CAS) remains to be determined.

Methods: We analyzed data from the Carotid Artery Stent (CAS) Registry.

Results: From 01/ 2000 to 06/2005 1322 CAS interventions were registered. In 94 (7.1%) procedures a GPII b/IIIa-A was used: abciximab in 8 cases (8.6%), tirofiban in 53 cases (57%) and eptifibatide in 32 cases (34.4%). The use of a GPII b/IIIa-A during CAS decreased significantly over time: from 17.6% in 2000 to 3% in 2005, p for trend <0.0001. The mean use of a GPII b/IIIa-A at the hospitals was 5.2%. More than 50% of the hospitals never used a GPII b/IIIa-A. There were no significant differences in baseline characteristics and concomitant diseases in CAS patients treated with GPII b/IIIa-A compared to those without GPII b/IIIa-A. A bilateral intervention was performed more often in patients treated with GPII b/IIIa-A (2.1 vs 0.2%, p = 0.04), a thrombus was more often visible (27 vs 12.4%, p <0.001) and an ulcer more frequently diagnosed (50 vs 37.5%, p = 0.03). There was no significant difference in the combined death or stroke rate between the two groups (5.3 vs 3.0%, p = 0.22, OR = 1.81, 95% CI: 0.69-4.72), which was confirmed by logistic regression analysis after adjusting for possible confounders (OR = 1.67, 95% CI: 0.62-4.46, p = 0.31).

Conclusions: Our data neither demonstrate a significant benefit nor a significant risk with the use of GPIIb/IIIa-A during CAS. However, only an adequately sized randomized controlled clinical trial could establish the real value of GPII b/IIIa-A during CAS. Until then, considering the potential increase in cerebral hemorrhage, we should not use GPII b/ IIIa-A routinely during CAS.

MeSH terms

  • Abciximab
  • Aged
  • Antibodies, Monoclonal / therapeutic use
  • Carotid Stenosis / therapy*
  • Eptifibatide
  • Female
  • Humans
  • Immunoglobulin Fab Fragments / therapeutic use
  • Logistic Models
  • Male
  • Middle Aged
  • Peptides / therapeutic use
  • Platelet Aggregation Inhibitors / therapeutic use*
  • Platelet Glycoprotein GPIIb-IIIa Complex / antagonists & inhibitors*
  • Registries
  • Stents*
  • Tirofiban
  • Tyrosine / analogs & derivatives
  • Tyrosine / therapeutic use

Substances

  • Antibodies, Monoclonal
  • Immunoglobulin Fab Fragments
  • Peptides
  • Platelet Aggregation Inhibitors
  • Platelet Glycoprotein GPIIb-IIIa Complex
  • Tyrosine
  • Tirofiban
  • Eptifibatide
  • Abciximab