Dual Antiplatelet Therapy After Iliac Artery Stenting Improves Limb Salvage and Freedom from Major Adverse Limb Events Compared to Single Antiplatelet Therapy

Background: Antiplatelet therapy is recommended by the Society for Vascular Surgery guidelines for patients following peripheral arterial intervention. However, there are no guidelines regarding the role of dual antiplatelet therapy (DAPT) following iliac interventions. The goal of this study was to assess whether there was clinical benefit to DAPT compared to single antiplatelet therapy following isolated iliac stenting. Methods: A retrospective study was conducted utilizing patients from the Vascular Quality Initiative database who underwent isolated iliac stenting from 2010 to 2022. Patients were separated into 4 cohorts based upon antiplatelet therapy at discharge: no APT, aspirin, clopidogrel, and DAPT. Those on DAPT or anticoagulation prior to the procedure were excluded. Univariable Kaplan-Meier and multivariable Cox regression analyses at 1 year postprocedure were conducted to evaluate overall survival, amputation-free survival, and major adverse limb event (MALE)-free survival. Results: A total of 1,375 (6.0%) patients were discharged on no APT, 6,045 (26.6%) on aspirin, 3,076 (13.5%) on clopidogrel, and 12,243 (53.8%) on DAPT. Patients discharged on any medication had improved 1-year survival (95.5% DAPT, 94.0% ASA, 94.8% clopidogrel, 82.5% no APT; P < 0.001), amputation-free survival (90.5% DAPT, 87.3% ASA, 89.1% clopidogrel, 73.4% no APT; P < 0.001), and MALE-free survival (87.3% DAPT, 84.0% ASA, 85.1% clopidogrel, 70.1% no APT; P < 0.001). DAPT had improved protection over aspirin with decreased risk of amputation (hazard ratio: 0.78, confidence interval: 0.69–0.87, P < 0.001) and risk of MALE (hazard ratio: 0.79, confidence interval: 0.71–0.87, P < 0.001). Hematoma rate was equivocal between all 4 cohorts within 30 days of the index procedure (3.05% no APT, 2.93% aspirin, 2.44% clopidogrel, 3.10% DAPT; P = 0.271). Conclusion: Antiplatelet therapy following isolated iliac stenting for PAD may be associated with increased survival, limb salvage, and freedom from MALE. DAPT over aspirin may be further associated with improved outcomes.