22. European Stroke Conference 941 Interventional neurology Common carotid artery stenting using an STA-FA pull-through technique K. Haraguchi1, S. Noshiro2, M. Nagai3, N. Matsuura4, K. Ogane5, T. Itou6 Hakodate Shintoshi Hospital, HAKODATE, JAPAN1, Hakodate Shintoshi Hospital, HAKO-DATE, JAPAN2, Hakodate Shintoshi Hospital, HAKODATE, JAPAN3, Hakodate Shintoshi Hospi-tal, HAKODATE, JAPAN4, Hakodate Shintoshi Hospital, HAKODATE, JAPAN5, Hakodate Shin-toshi Hospital, HAKODATE, JAPAN6 Background Surgical treatment of the origin of the common carotid artery requires a thoracotomy, so percutaneous stenting, which is less invasive, has been considered in its stead. However, consis-tent placement of the stent may not be possible because a guiding catheter may slip given lesions closer to the aorta and the angle at which the common carotid arteries branch from the aorta is acute. These aspects can hamper stenting. Reported here is stenting via a pull-through technique whereby a guidewire is passed from the superficial temporal artery (STA) to the femoral artery (FA) to facili-tate consistent placement of the guiding catheter. Methods Two patients with stenosis of the origin of a common carotid artery were treated. Under general anesthesia, an 8-French guiding catheter was placed in the aortic arch via a transfemoral approach. Next, an incision of 2 cm was made in front of the ear on the side the lesion was located. The STA was surgically exposed and punctured retrogradely with a 20-gauge indwelling needle. A 300-cm 0.014 guidewire was inserted into the aortic arch via the STA. A gooseneck snare was then inserted via a guiding catheter, and the guidewire inserted via the STA was retained at the aortic arch. The guidewire was advanced through the guiding catheter and pulled through. The guidewire that had been passed from the STA to the FA was then used to angioplasty and stenting the origin of a common carotid artery with distal balloon protection. Results In both patients, passing the guidewire through led to consistent positioning of the guiding catheter. Angioplasty and stenting of the origin of a common carotid artery was performed success-fully. 844 © 2013 S. Karger AG, Basel Scientific Programme Conclusion The current technique is a useful way to prevent slipping of a guiding catheter and pro-vide consistent stent placement, allowing treatment of conditions besides stenosis of the origin of a common carotid artery. 942 Interventional neurology Effects of CYP2C19 polymorphism on clopidogrel treatment in patients with carotid stenosis treated with stent. F. Moniche1, J.R. Gonzalez-Marcos2, I. Gutierrez3, J.R. Garcia-Lozano4, F. Torrecillas5, A. Cayue-la6, A. Mayol7, A. Gonzalez8 Hospital Universitario Virgen del Rocio, Seville, SPAIN1, Hospital Universitario Virgen del Ro-cio, Seville, SPAIN2, Hospital Universitario Virgen del Rocio, Seville, SPAIN3, Hospital Universi-tario Virgen del Rocio, Seville, SPAIN4, Hospital Universitario Virgen del Rocio, Seville, SPAIN5, Hospital Universitario Virgen del Rocio, Seville, SPAIN6, Hospital Universitario Virgen del Rocio, Seville, SPAIN7, Hospital Universitario Virgen del Rocio, Seville, SPAIN8 Introduction Clopidogrel is a prodrug that requires conversion into an active metabolite via cytochrome P450 (CYP) in the liver, in order to irreversibly inhibits the P2Y12 adenosine diphosphate platelet re-ceptor. CYP2C19 polymorphism has been reported to correlate with reduced antiplatelet activity of clopidogrel in coronary artery disease. We assessed the association between CYP2C19 polymor-phism and clopidogrel resistance in patients with carotid stenosis treated with stent. Materials and methods VerifyNow P2Y12 assay was used to test clopidogrel resistance. A PRU value higher of 240 identi-fied resistant patients. Genomic DNA was extracted from blood leukocytes using QIAmp DNA Mini Kit. Genotyping was performed using “TaqMan® SNP Genotyping Assays” in a LightCycler 480. Patients were genotyped for three single-nucleotide polymorphisms (*2, *3, *17) that define the ma-jor CYP2C19 alleles. Patients were classified into categories of metaboliser phenotypes with the use of established common-consensus star allele nomenclature (“ultrarapid metabolisers”, “extensive metabolisers”, “intermediate metabolisers” and “poor metabolisers”). Results Based on their genetic makeup, 141 patients were enrolled (mean age;67,1, 78,7% men, 30.5% asymtomatic). 29.8% of patients were considered ultrarapid, 44,7% extensive and 25.5% were inter-mediate or poor metabolisers. The PRU values of intermediate and poor metabolisers (PRU 251±87) were higher than those of extensive (220±85) and ultrarapid metabolisers (208±63) (p=0,01). Only 33,3% of intermediate and poor metabolisers were responder to clopidogrel (vs 52.4% and 61.9%, p=0.04, respectively). Conclusion Intermediate and poor metabolisers CYP2C19 is associated with reduced clopidogrel antiplatelet ac-tivity in patients with carotid stenosis. The clinical implications of this finding require further inves-tigation.
Karger_ESC London_2013
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