Comparative Study on Patient with Undergoing Intracranial Stent Placement Using Aspirin/Clopidogrel versus Aspirin/Ticagrelor
Authors: Liang XIaohan , Hao Zhiwei , Fu YIdian , Yin Kuochang , Xu Guoedong , Lv Peiyuan 
Published: April 2024

Background
In recent years, with the development of neurointerventional medicine, an increasing number of patients have chosen to undergo intracranial stent placement to achieve vascular recanalization, thereby improving symptoms caused by cerebral infarction. Therefore, maintaining smooth blood flow within intracranial stents has become a critical issue. Due to the phenomenon of clopidogrel resistance in some patients, the efficacy of reducing platelet aggregation with the aspirin/clopidogrel dual antiplatelet regimen is relatively low, leading to a higher incidence of intrastent restenosis and increasing patient burden. In recent years, the use of the aspirin/ticagrelor regimen in clinical practice has increased year by year, yet the safety and efficacy of the aspirin/ticagrelor regimen have not been fully validated. This study aims to compare the effects and safety of aspirin/ticagrelor and aspirin/clopidogrel in dual antiplatelet therapy on platelet aggregation and prognosis in patients undergoing neurointerventional treatment and explore whether aspirin/ticagrelor can replace aspirin/clopidogrel as a better dual antiplatelet regimen.
Methods
We conducted a retrospective analysis of patients who underwent intracranial stent placement. From April 2019 to October 2023, patients undergoing stent placement were grouped based on the dual antiplatelet regimen used, categorized into the aspirin/clopidogrel group and the aspirin/ticagrelor group. We compared the platelet aggregation rates, NIHSS scores, and MRS scores between the two groups. Additionally, we documented occurrences of bleeding and adverse drug reactions in both groups during a continuous 6-month follow-up period. At the final 6-month follow-up, we performed repeat percutaneous cerebral angiography to compare the degree of stenosis within the stents between the two groups.
Results
A total of 332 patients undergoing intracranial stent placement were included in the study. 56 patients did not undergo cerebral angiography at the final 6-month follow-up and were excluded. (1) The remaining 276 patients were compared (clopidogrel group n = 86, ticagrelor group n = 190), and there were no statistically significant differences in baseline data between the two groups. (2) Platelet aggregation was significantly lower in the ticagrelor group compared to the clopidogrel group 3 days after medication (24.95%±10.52% vs 32.29%±11.58%, P < 0.001). (3) Within 6 months, 1 case (1.16%) of cerebral hemorrhage occurred in the clopidogrel group and 3 cases (1.58%) occurred in the ticagrelor group. There were no deaths in either group, and there was no statistically significant difference in bleeding and other adverse events between the two groups. (4) After 6 months, cerebral angiography revealed severe or greater intrastent restenosis in 20 cases (23.26%) in the clopidogrel group and 19 cases (10.00%) in the ticagrelor group. The difference in severe intrastent restenosis between the two groups was statistically significant, with the probability of severe intrastent restenosis in the clopidogrel group being 2.805 times that of the ticagrelor group. Ticagrelor was superior to clopidogrel in preventing intrastent restenosis (P = 0.004, 95% CI 1.391%-5.654%).
Conclusion
In our study of patients undergoing intracranial stent placement, the efficacy of aspirin/ticagrelor as a dual antiplatelet regimen was significantly higher than that of aspirin/clopidogrel, and its impact on platelet aggregation was greater. The ticagrelor group was significantly better than the clopidogrel group in reducing intrastent restenosis. The risks of bleeding and death associated with the ticagrelor group were not statistically different from those of the clopidogrel group. The aspirin/ticagrelor regimen may be a better postoperative dual antiplatelet regimen than aspirin/clopidogrel.