@article{3030593,
    title = "Comparison of Ticagrelor Versus Clopidogrel on Cerebrovascular
Microembolic Events and Platelet Inhibition during Transcatheter Aortic
Valve Implantation",
    author = "Vavuranakis, Michael A. and Kalantzis, Charalampos and Voudris, Vassilis and and Kosmas, Elias and Kalogeras, Konstantinos and Katsianos, Efstratios and and Oikonomou, Evaggelos and Siasos, Gerasimos and Aznaouridis, and Konstantinos and Toutouzas, Konstantinos and Stasinopoulou, Myrsini and and Tountopoulou, Argyro and Bei, Evangelia and Moldovan, Carmen M. and and Vrachatis, Dimitrios and Iakovou, Ioannis and Papaioannou, Theodore G. and and Tousoulis, Dimitrios and Leucker, Thorsten M. and Vavuranakis, and Manolis",
    journal = "AMERICAN JOURNAL OF CARDIOLOGY",
    year = "2021",
    volume = "154",
    pages = "78-85",
    publisher = "EXCERPTA MEDICA INC-ELSEVIER SCIENCE INC",
    issn = "0002-9149",
    doi = "10.1016/j.amjcard.2021.05.047",
    abstract = "The impact of the antiplatelet regimen and the extent of associated
platelet inhibition on cerebrovascular microembolic events during
transcatheter aortic valve implantation (TAVI) are unknown. Our aim was
to evaluate the effects of ticagrelor versus clopidogrel and of platelet
inhibition on the number of cerebrovascular microembolic events in
patients undergoing TAVI. Patients scheduled for TAVI were randomized
previous to the procedure to either aspirin and ticagrelor or to aspirin
and clopidogrel. Platelet inhibition was expressed in P2Y12 reaction
units (PRU) and percentage of inhibition. High intensity transient
signals (HITS) were assessed with transcranial Doppler (TCD). Safety
outcomes were recorded according to the VARC-2 definitions. Among 90
patients randomized, 6 had an inadequate TCD signal. The total number of
procedural HITS was lower in the ticagrelor group (416.5 [324.8,
484.2]) (42 patients) than in the clopidogrel group (723.5 [471.5,
875.0]) (42 patients), p <0.001. After adjusting for the duration of the
procedure, diabetes, extra-cardiac arteriopathy, BMI, hypertension,
aortic valve calcium content, procedural ACT, and pre-implantation
balloon valvuloplasty, patients on ticagrelor had on average 256.8 (95%
CI: [-335.7, -176.5]) fewer total procedural HITS than patients on
clopidogrel. Platelet inhibition was greater with ticagrelor 26 [10,
74.5] PRU than with clopidogrel 207.5 (120 to 236.2) PRU, p <0.001, and
correlated significantly with procedural HITS (r = 0.5, p <0.05). In
conclusion, ticagrelor resulted in fewer procedural HITS, compared with
clopidogrel, in patients undergoing TAVI, while achieving greater
platelet inhibition. (c) 2021 Published by Elsevier Inc."
}