Safety and efficacy of 3-month Dual Antiplatelet Therapy After Carotid Artery Stenting: A Retrospective Propensity Score-Matched Analysis

The optimal duration of dual antiplatelet therapy (DAPT) following carotid artery stenting (CAS) is unclear. Therefore, this study aimed to compare outcomes across four centers with differing DAPT strategies-3-month versus extended duration-to assess safety and efficacy. We retrospectively evaluated 347 patients who underwent CAS between 2010 and 2022. Patients were categorized into two groups according to DAPT duration:3 months or >3 months. We compared patient backgrounds, postoperative stroke events, and DAPT-related hemorrhagic complications. Propensity score matching was performed, and 80 matched pairs were analyzed. In the matched cohort of 80 pairs, the incidence of ischemic events, including cerebral infarction and transient ischemic attack, was four and 10 in the 3-month DAPT and >3-month DAPT groups, respectively. Intracranial and extracranial hemorrhagic events occurred in two and seven cases in the 3-month and >3-month groups, respectively. Log-rank testing showed a statistically significant association between >3-month DAPT and higher incidence of hemorrhagic complications (including intracranial and extracranial hemorrhage) (hazard ratio HR: 6.21, 95% confidence interval CI 1.23-31.4, p=0.014), whereas no significant difference was observed in ischemic event rates (HR 2.90, 95% CI 0.89-9.46, p=0.077). In our series of CAS patients treated with DAPT, a 3-month regimen before transitioning to SAPT was associated with similar efficacy and a lower incidence of hemorrhages compared to longer DAPT regimens. High-risk ischemic cases should be considered individually; however, routine extension of DAPT beyond 3 months may not be necessary.