Symptomatic carotid stenosis patients are at high risk of early recurrent stroke.

The CARESS ( Clopidogrel and Aspirin for Reduction of Emboli in Symptomatic Carotid Stenosis ) trial evaluated antiplatelet therapy, and the feasibility of an method based on asymptomatic microembolic signals ( MES ), detected by transcranial Doppler ultrasound, as markers of future stroke and transient ischemic attack ( TIA ) risk.

The patients with symptomatic >/=50% carotid stenosis, were screened with transcranial Doppler ultrasound, and if MES were detected, they were randomized to Clopidogrel ( Plavix ) and Aspirin or Aspirin monotherapy.

MES were detected in 110 of 230 patients, of whom 107 were randomized.

Intention-to-treat analysis revealed a significant reduction in the primary end point: 43.8% of patients treated with Cliopidogrel and Aspirin were MES positive on day 7, as compared with 72.7% of monotherapy patients ( relative risk reduction 39.8% ).

The secondary end point of MES frequency per hour was reduced ( compared with baseline ) by 61.4% in the dual-therapy group at day 7 and by 61.6% on day 2.

There were 4 recurrent strokes and 7 TIAs in the monotherapy group versus no stroke and 4 TIAs in the dual-therapy group.

The results of the study showed that in patients with recently symptomatic carotid stenosis, combination therapy with Clopidogrel and Aspirin is more effective than Aspirin alone in reducing asymptomatic embolization.
Doppler MES detection is a feasible method to evaluate the efficacy of antiplatelet therapy

Source: Circulation, 2005


XagenaMedicine2005