Impact of ticagrelor and aspirin versus clopidogrel and aspirin in symptomatic patients with peripheral arterial disease: Thrombus burden assessed by optical coherence tomography

Xiao Yang, Massoud A. Leesar, Hinan Ahmed, Vasili Lendel, Gerardo Rodriguez, Deniz Mutlu, Ian Cawich, Anand Prasad, Meagan Oglesby, Kostas Marmagkiolis, Nathanael E. Phillips, Dijkstra Jouke, Joel Michalek, Qianqian Liu, Thomas Milner, Austin McElroy, Taylor Hoyt, Marc D. Feldman, Mehmet Cilingiroglu

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Purpose: To compare OCT identified white thrombus decline, neointimal hyperplasia and clinical outcomes of patients treated with ticagrelor plus aspirin with those patients treated with clopidogrel plus aspirin after peripheral interventions. Background: Ticagrelor is a potent platelet inhibitor. In patients with coronary artery disease, ticagrelor and aspirin demonstrated reduced rates of stent thrombosis, compared to aspirin and clopidogrel. The clinical importance of potent antiplatelet inhibition after peripheral endovascular interventions is unknown. Methods: We enrolled 18 patients with superficial femoral artery disease and the presence of OCT-detected clot post-stent placement. Patients were randomized to 75 mg clopidogrel once daily for 1 month vs. 90 mg ticagrelor twice daily for 6 months, both in addition to 81 mg aspirin for 6 months. Clot volumes, ankle-brachial index (ABI), 6-minute walk test, and Rutherford classification were measured at baseline and 6-month follow-up. Neointimal hyperplasia and neovascularization were calculated at 6-month follow-up. Results: N = 11 patients were enrolled in the clopidogrel group and N = 7 in the ticagrelor group. There was a significantly greater decrease in white thrombus in the ticagrelor group (median volume/stent length (0.067 vs 0.014 mm3/mm, p = 0.05)). No differences were found in % neointima (0.412 vs 0.536 mm3/mm, p = 0.44) and neovascularization (28 vs 44, p = 0.16). ABI and Rutherford classification were improved significantly after 6 months in the clopidogrel group, with no difference between groups at 6 months in ABI or Rutherford. Conclusion: In symptomatic patients with PAD, ticagrelor showed significant improvement relative to clopidogrel with respect to white thrombus burden decline.

Original languageEnglish (US)
Pages (from-to)778-784
Number of pages7
JournalCardiovascular Revascularization Medicine
Volume19
Issue number7
DOIs
StatePublished - Oct 2018

Keywords

  • Thrombus burden
  • neointimal hyperplasia
  • optical coherence tomography
  • peripheral artery disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Yang, X., Leesar, M. A., Ahmed, H., Lendel, V., Rodriguez, G., Mutlu, D., Cawich, I., Prasad, A., Oglesby, M., Marmagkiolis, K., Phillips, N. E., Jouke, D., Michalek, J., Liu, Q., Milner, T., McElroy, A., Hoyt, T., Feldman, M. D., & Cilingiroglu, M. (2018). Impact of ticagrelor and aspirin versus clopidogrel and aspirin in symptomatic patients with peripheral arterial disease: Thrombus burden assessed by optical coherence tomography. Cardiovascular Revascularization Medicine, 19(7), 778-784. https://doi.org/10.1016/j.carrev.2018.02.013