{
  "abstract": "Background Dual antiplatelet therapy (DAPT) is recommended around carotid artery stenting (CAS) to reduce periprocedural stroke risk. Clopidogrel is widely used, but response variability related to pharmacokinetics and CYP2C19 polymorphisms may limit its effectiveness. Ticagrelor is a more potent, direct acting P2Y12 inhibitor, but its comparative effectiveness in CAS remains uncertain.Methods We conducted a retrospective cohort study in the TriNetX database, identifying adults with carotid artery stenosis who underwent CAS between January 2016 and August 2025 and received either ticagrelor or clopidogrel. Primary outcomes at 180 days included ischemic stroke, major hemorrhage, intracranial hemorrhage, and all cause mortality. Secondary outcomes included inpatient readmission and emergency department (ED) visits. Propensity score matching (1:1), Kaplan–Meier survival, and Cox proportional hazards analysis were used.Results Among 6996 patients, 378 received ticagrelor and 6618 received clopidogrel; aspirin co-use was similar (89.7% vs 91.7%). After matching, 377 patients remained in each cohort. Ischemic stroke (2.7% vs 4.2%; HR 0.56, 95% CI 0.25 to 1.27; P=0.159) and major hemorrhage (2.9% vs 4.8%; HR 0.61, 95% CI 0.29 to 1.30; P=0.197) were numerically lower with ticagrelor. Rates of intracranial hemorrhage were similar (2.7% vs 2.7%; HR 0.61, 95% CI 0.14 to 2.53; P=0.488). Mortality was numerically higher with ticagrelor (3.4% vs 2.7%; HR 1.64, 95% CI 0.68 to 3.97; P=0.263). ED visits were similar (14.3% vs 14.6%; HR 0.97, 95% CI 0.67 to 1.42; P=0.895). Inpatient readmission was numerically lower with ticagrelor (15.9% vs 19.1%; HR 0.81, 95% CI 0.57 to 1.14; P=0.223).Conclusion Ticagrelor and clopidogrel showed comparable safety and effectiveness following CAS. Future prospective genotype informed trials are warranted to confirm these findings.",
  "authors": [
    {
      "affiliations": [
        "Division of Neuroradiology, Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA"
      ],
      "name": "Jay Kakadiya"
    },
    {
      "affiliations": [
        "Department of Neurology, University of Maryland Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Huanwen Chen"
    },
    {
      "affiliations": [
        "School of Medicine, University of Oxford, Oxford, UK"
      ],
      "name": "Arsh Patankar"
    },
    {
      "affiliations": [
        "Department of Radiology, Division of Neuroradiology, University of Texas MD Anderson Cancer Center, Houston, Texas, USA"
      ],
      "name": "Hamza A Salim"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Montefiore Medical Center, New York, New York, USA"
      ],
      "name": "Muhammed Amir Essibayi"
    },
    {
      "affiliations": [
        "Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA"
      ],
      "name": "Pranjal Rai"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, Montefiore Einstein Medical Center, New York, New York, USA",
        "Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA"
      ],
      "name": "Ahmed Y Azzam"
    },
    {
      "affiliations": [
        "Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA"
      ],
      "name": "Amelia K Adcock"
    },
    {
      "affiliations": [
        "Division of Neuroradiology, Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, Maryland, USA"
      ],
      "name": "Vivek S Yedavalli"
    },
    {
      "affiliations": [
        "Neuroendovascular Program, Massachusetts General Hospital and Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA",
        "Neurointerventional and Neuroanalytics Consortium (NAN-C), School of Medicine, Toronto Metropolitan University, Toronto, Ontario, Canada"
      ],
      "name": "Adam A Dmytriw"
    },
    {
      "affiliations": [
        "Department of Radiology, Oregon Health and Science University, Portland, Oregon, USA"
      ],
      "name": "Marco Colasurdo"
    },
    {
      "affiliations": [
        "Department of Radiology, Yale University School of Medicine, New Haven, Connecticut, USA"
      ],
      "name": "Ajay Malhotra"
    },
    {
      "affiliations": [
        "Department of Neurosurgery, University of Maryland Medical Center, Baltimore, Maryland, USA"
      ],
      "name": "Dheeraj Gandhi"
    },
    {
      "affiliations": [
        "Department of Neuroradiology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA",
        "Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA",
        "Department of Neurosurgery, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, West Virginia, USA"
      ],
      "name": "Dhairya A Lakhani"
    }
  ],
  "title": "Safety and efficacy of ticagrelor versus clopidogrel for carotid artery stenting: propensity score matched analysis",
  "uid": "729239ab-f27a-5c76-aab6-9abfb6c47d9c"
}