ABSTRACT NUMBER: ESOC2026A24 ANTITHROMBOTIC THERAPY IN ATRIAL FIBRILLATION AND CAROTID REVASCULARIZATION: WHEN NEUROLOGICAL EVIDENCE REMAINS UNDEFINED

Abstract Background and aims The coexistence of atrial fibrillation (AF) and the need for carotid intervention is uncommon, limiting the available evidence on optimal antithrombotic management. Based on this premise, we aimed to evaluate the safety and efficacy of two antithrombotic strategies at one month and one year following carotid artery stenting (CAS) in patients with AF receiving direct oral anticoagulants (DOACs). Methods Single-center retrospective cohort study including patients undergoing CAS between May 2018 and May 2025. Patients with non-valvular AF on DOAC therapy were included. Two groups were compared: dual therapy (DOAC + clopidogrel) and triple therapy (DOAC + clopidogrel + aspirin). Baseline characteristics, bleeding events, stent thrombosis/restenosis, and stroke recurrence were assessed at one month and one year post-procedure. Results Of 535 patients treated with CAS, 41 had AF, and 29 met the inclusion criteria (mean age 75.4 years; 31% women). There were no significant differences in baseline characteristics or complication rates between groups. No adverse events were recorded within the first month. During the first year, one stroke occurred in each group, one asymptomatic major bleeding event was reported, and four stent restenoses were observed—three in the dual therapy group and one in the triple therapy group. Conclusions In our cohort, no statistically significant differences in complications were observed between dual and triple antithrombotic therapy at one month or one year post-CAS. Larger studies are needed to establish evidence-based clinical recommendations. Conflict of interest Ignacio Ruiz Salcedo: nothing to disclose. Figure 1 - belongs to Results