Correlation Between Clopidogrel Resistance And CYP2C19 Gene Polymorphism And Restenosis After Interventional Therapy For Lower Limb Arteriosclerosis Obliterans

Objective:1.To observe the antiplatelet reactivity of clopidogrel and its correlation in patients with lower extremity arteriosclerosis obliterans carrying different CYP2C19 genotypes2.To evaluate the correlation between clopidogrel resistance and restenosis after angioplasty for lower extremity arteriosclerosis obliterans Materials and methods:A total of 165 patients with lower limb atherosclerosis obliterans(ASO)who underwent endovascular treatment of femoral and popliteal artery in the first interventional ward of Shengjing Hospital affiliated to China Medical University from February 2016 to February 2018 were collected.The patients received conventional oral clopidogrel 75mg/ day and aspirin 100mg/ day biantibody therapy before surgery for 5 days,then underwent endovascular treatment,and the single nucleotide polymorphism of CYP2C19 gene regulating clopidogrel metabolic activity was detected within 3 days after surgery.Thromboelastography was used to detect ADP inhibition rate of platelets.The patients were followed up after discharge(through telephone contact or outpatient review).A total of 94 ASO patients were followed up after vascular stent implantation and drug balloon dilation.The patency of target vessels was evaluated by imaging methods such as ultrasound,double lower limb DSA(re-intervention of patients)or CTA.The observation target was the patency rate of target vessels 6 months after operation.Spearman correlation analysis was used to evaluate the correlation between clopidogrel resistance and CYP2C19 variant genotypes.Logistic regression analysis was used to screen independent risk factors including clopidogrel resistance leading to restenosis of lower limb artery,which was statistically significant with P<0.05.Results:Of 165 patients collected,78 were normal metabolic type,87 were abnormal metabolic type(intermediate metabolic type + slow metabolic type),and 35 had clopidogrel resistance.Spearman correlation analysis showed that CYP2C19 gene polymorphism was correlated with clopidogrel resistance(r=-0.165,p=0.035).In the follow-up of 94 patients,42 patients had restenosis or occlusion and 18 patients had clopidogrel resistance..Logistics regression analysis showed that clopidogrel resistance had a correlation with restenosis after angioplasty for lower extremity arteriosclerosis obliterans(p=0.042).Conclusion:The occurrence of clopidogrel resistance is correlated with CYP2C19 gene polymorphism.Lower limb ASO patients treated with clopidogrel can infer whether clopidogrel resistance exists by detecting its genotype.Vascular restenosis of lower limb ASO patients after interventional endovascular treatment is correlated with the occurrence of clopidogrel resistance.It is suggested that lower limb ASO patients receiving interventional endovascular treatment should detect the presence of clopidogrel resistance as soon as possible and change the treatment plan in time so as to enable more patients to obtain better treatment effect.