A carotid stenosis is treated with invasive procedures of revascularization when the lumen is
reduced by more than 70% or when the lumen is reduced by more than 50% in patients who have
had symptoms attributable to the affected carotid district in last the 6 months.
Two options for the treatment of patients with carotid stenosis exist currently: the
traditional surgical intervention of removal of the plaque by carotid endoarterectomy
(CEA)and percutaneous transluminal carotid angioplasty with a balloon associated to the
positioning of a stent through a catheter brought directly in the carotid artery (CAS).
The main complication of both the procedures is early thrombosis, a phenomenon in which
platelets play a central role. The importance of an effective inhibition of platelet
activation in these patients has been widely demonstrated.
Clinical studies in patients undergoing PTCA have demonstrated that the optimal treatment for
the prevention of stent thrombosis is a dual antiplatelet regimen with aspirin plus
clopidogrel, as compared with the single drugs. Given that no specific clinical trial has
assessed the best antiplatelet therapeutic regimen in CAS with stenting, by extension from
these findings in ischemic heart disease CAS patients are treated with aspirin plus
Several studies have demonstrated that an elevated residual platelet reactivity despite
treatment with clopidogrel is associated to an increased risk of major adverse cardiovascular
events (MACE) after stenting for coronary disease.
No data are instead available on the possible predictive value of residual platelet
reactivity for the incidence of ischemic cardiovascular events in patients with
atherosclerotic carotid disease undergoing CAS with stenting.
Aim of the study will be to assess the predictive value of residual platelet reactivity, as
measured by different laboratory tests in patients undergoing CAS with stenting and treated
with aspirin plus clopidogrel, for the incidence of cardiovascular complications (major
adverse ischemic events).