JACC：氯吡格雷与阿托伐他汀可预防颈动脉支架置入患者卒中

　　 意大利学者的一项研究表明，在接受颈动脉支架置入的患者中，600 mg负荷剂量氯吡格雷和大剂量阿托伐他汀短期再负荷应用均可预防早期脑缺血性事件。论文于2013年3月9日在线发表于《美国心脏病学会杂志》（J Am Coll Cardiol），同时于美国心脏病学会第62届科学年会（ACC2013）上公布。

　　此项2 × 2析因设计研究共纳入156例接受保护性颈动脉支架置入的患者。在介入前6小时给予600 mg（78例）或300 mg（78例）氯吡格雷负荷应用；给予阿托伐他汀再负荷应用（76例；操作前12小时启动80 mg+40 mg）或不给予他汀类再负荷（80例）。主要终点为30天短暂性脑缺血发作/卒中发病率，或24～48小时脑弥散加权MRI所示新发缺血性病变。

　　结果显示，600 mg氯吡格雷组的主要转归指标发生率显著低于300 mg组（18%对35.9%；P=0.019），并且阿托伐他汀再负荷组的发生率显著低于非他汀类再负荷组（18.4%对35.0%；P=0.031）。大剂量氯吡格雷亦可显著减少30天时短暂性脑缺血发作/卒中（0%对9%；P=0.02），并且未升高出血风险。

与卒中相关的拓展阅读：

• Stroke：亚临床甲亢为卒中后功能转归不佳危险因素
• Stroke:新型眼部运动装置辅助诊断后循环卒中
• STROKE：有氧锻炼有助改善慢性卒中患者康复
• Stroke：DTI成像显示皮质网状通路与慢性卒中患者行走能力相关
• Stroke：冠状动脉钙化为卒中独立预测因子
更多信息请点击：有关卒中更多资讯

Strategies of Clopidogrel Load and Atorvastatin Reload to Prevent Ischemic Cerebral Events in Patients Undergoing Protected Carotid Stenting

Results of the Randomized ARMYDA-9 CAROTID Study

Objectives  

This study sought to evaluate whether a strategy with a 600-mg clopidogrel load and a short-term, high-dose atorvastatin reload would improve outcomes in clopidogrel-naïve, statin-treated patients undergoing protected carotid stenting.

Background  

Optimal clopidogrel loading dose during carotid stenting has not been investigated; in addition, statin neuroprotection in this setting has not been described.

Methods  

A total of 156 patients were randomized using a 2 × 2 factorial design to receive either a 600-mg (n = 78) or 300-mg (n = 78) clopidogrel load given 6 h before intervention and either a atorvastatin reload (n = 76; 80 mg + 40 mg initiating 12 h before the procedure) or no statin reload (n = 80). The primary endpoint was the 30-day incidence of transient ischemic attack/stroke or new ischemic lesions on cerebral diffusion-weighted magnetic resonance imaging performed at 24 to 48 h.

Results  

Occurrence of the primary outcome measure was significantly lower in the 600-mg clopidogrel arm (18% vs. 35.9% in the 300-mg group; p = 0.019) and in the atorvastatin reload arm (18.4% vs. 35.0% in the no statin reload group; p = 0.031). High-dose clopidogrel also significantly reduced the transient ischemic attack/stroke rate at 30 days (0% vs. 9%, p = 0.02, secondary endpoint), without an increase in bleeding risk.

Conclusions  

In patients undergoing carotid stenting, a strategy using both a 600-mg clopidogrel load and a short-term reload with high-dose atorvastatin protects against early ischemic cerebral events. These results, obtained along with routine mechanical neuroprotection, provide new evidence of the optimization of drug therapy before percutaneous carotid intervention. (Clopidogrel and Atorvastatin Treatment During Carotid Artery Stenting [ARMYDA-CARO], NCT01572623)