The role of platelets and the importance of platelet inhibition are well established in patients with vascular disease. When physicians perform revascularization procedures in these patients, who typically have the most advanced atherosclerotic disease, they should be aware of both the generic benefits of platelet inhibition on patients' long-term health as well as the specific benefits relative to operative or endovascular revascularization. Platelet inhibition has not been well studied in the aortoiliac system, renal vascular bed, or the mesenteric arterial bed. Peripheral vascular beds that have been studied are predominantly the carotid circulation and the infrainguinal vasculature. This article reviews the basic mechanisms of platelet inhibition and suggests antiplatelet strategies for vascular interventions, including carotid endarterectomy, carotid angioplasty and stenting, infrainguinal bypass, and peripheral angioplasty and stenting.
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