Outcomes of Stent Angioplasty Based on Postoperative Antiplatelet Regimen for Isolated Iliac Occlusive Disease

Abstract

Antiplatelet therapy following stent angioplasty for lower extremity peripheral arterial disease is recommended. To date, however, the ideal number of agents and length of treatment for iliac artery intervention are yet to be determined. The goal of this study is to determine whether single antiplatelet therapy (SAPT) or dual antiplatelet therapy (DAPT) is superior and how long this regimen should be administered in the postoperative period. Patients with arterial occlusive disease receiving isolated iliac artery stent angioplasty (including both common iliac artery and/or external iliac artery) registered in the Society for Vascular Surgery Vascular Quality Initiative Peripheral Vascular Intervention module between 2010 and 2021 were included. Patients were stratified into two groups: (1) DAPT (aspirin and P2Y12 inhibitor) and (2) SAPT, to include aspirin or P2Y12 inhibitor. Outcomes were evaluated based on antiplatelet therapy at discharge and at 1-year follow-up. Primary outcome measures of mortality, major adverse limb events, major adverse cardiac events, and need for reintervention were assessed using univariate analysis. A P value of <.05 was set as significance criterion. A total of 5615 patients meeting inclusion criterion were analyzed with 3859 (68.7%) in group 1 (DAPT) and 1756 (31.3%) in group 2 (SAPT). Average age of the population was 65.4 ± 10.7 years with 3200 males (57%) and 2413 females (43%). Patients in the DAPT group were found to have lower mortality at 1 year (3.1% vs SAPT = 11.7%; P < .001) with more patients undergoing minor amputations (DAPT 46.2% vs SAPT 31%; P < .001), but with no significant difference between those requiring major amputations (P = .097). The DAPT group was also found to require more reinterventions (5.5% vs SAPT = 4%, P = .01). There was no significant difference in major adverse cardiac events (P = .217) or in major adverse limb events (P = .10) between the two groups. At the 1-year follow-up, patients receiving isolated iliac artery stent angioplasty for occlusive disease treated with DAPT therapy were found to have lower mortality with an increase in reinterventions. There was no significant difference in major adverse cardiac events or in major adverse limb events between DAPT and SAPT regimens.