Comparative Analysis of In-Stent Stenosis or Occlusion Following Carotid Artery Stenting in Patients Undergoing Anticoagulant Versus Antiplatelet Treatment

By
Mert Kök
Reinoud P. H. Bokkers
Aryan Mazuri
Saloua Akoudad
Maarten Uyttenboogaart
Clark J. Zeebregts
June 28, 2026

Journal Of Endovascular Therapy

Objective:

To compare the incidence of in-stent stenosis or occlusion and the associated thromboembolic and bleeding risks in patients undergoing carotid artery stenting (CAS) treated with anticoagulants versus those treated with antiplatelet therapy.

Approach:

Patient Selection: Eligible patients were identified based on specific criteria, excluding those with combined procedures, technical failures, or certain other conditions.

Key Findings:

The incidence of in-stent stenosis or occlusion varies widely in the literature, with reported rates of severe restenosis at 10.0% and ≥50% stenosis progression at 20.2%.
DAPT has been shown to reduce the 30-day risk of ipsilateral thromboembolic events compared to single antiplatelet therapy without significantly increasing bleeding risk.
Limited data exist on the use of DOACs in patients undergoing CAS, raising concerns about balancing thromboembolic and bleeding risks.

Interpretation:

The study aims to provide insights into the comparative outcomes of antithrombotic strategies in patients undergoing CAS, particularly in the context of increasing DOAC use.

Limitations:

The study is retrospective and conducted at a single center, which may limit generalizability.
Data on long-term outcomes and the efficacy of DOACs in this specific population are limited.