TY - JOUR
T1 - Considerations for antiplatelet management of carotid stenting in the setting of mechanical thrombectomy
T2 - A delphi consensus statement
AU - Goyal, M.
AU - Yoshimura, S.
AU - Milot, G.
AU - Fiehler, J.
AU - Jayaraman, M.
AU - Dorn, F.
AU - Taylor, A.
AU - Liu, J.
AU - Albuquerque, F.
AU - Jensen, M. E.
AU - Nogueira, R.
AU - Fraser, J. F.
AU - Chapot, R.
AU - Thibault, L.
AU - Majoie, C.
AU - Yang, P.
AU - Sakai, N.
AU - Kallmes, D.
AU - Orlov, K.
AU - Arthur, A.
AU - Brouwer, P.
AU - Ospel, J. M.
N1 - Publisher Copyright:
© 2020 American Society of Neuroradiology. All rights reserved.
PY - 2020/12/1
Y1 - 2020/12/1
N2 - BACKGROUND AND PURPOSE: There are only few data and lack of consensus regarding antiplatelet management for carotid stent placement in the setting of endovascular stroke treatment. We aimed to develop a consensus-based algorithm for antiplatelet management in acute ischemic stroke patients undergoing endovascular treatment and simultaneous emergent carotid stent placement. MATERIALS AND METHODS: We performed a literature search and a modified Delphi approach used Web-based questionnaires that were sent in several iterations to an international multidisciplinary panel of 19 neurointerventionalists from 7 countries. The first round included open-ended questions and formed the basis for subsequent rounds, in which closed-ended questions were used. Participants continuously received feedback on the results from previous rounds. Consensus was defined as agreement of $70% for binary questions and agreement of $50% for questions with.2 answer options. The results of the Delphi process were then summarized in a draft manuscript that was circulated among the panel members for feedback. RESULTS: A total of 5 Delphi rounds were performed. Panel members preferred a single intravenous aspirin bolus or, in jurisdictions in which intravenous aspirin is not available, a glycoprotein IIb/IIIa receptor inhibitor as intraprocedural antiplatelet regimen and a combination therapy of oral aspirin and a P2Y12 inhibitor in the postprocedural period. There was no consensus on the role of platelet function testing in the postprocedural period. CONCLUSIONS: More and better data on antiplatelet management for carotid stent placement in the setting of endovascular treatment are urgently needed. Panel members preferred intravenous aspirin or, alternatively, a glycoprotein IIb/IIIa receptor inhibitor as an intraprocedural antiplatelet agent, followed by a dual oral regimen of aspirin and a P2Y12 inhibitor in the postprocedural period.
AB - BACKGROUND AND PURPOSE: There are only few data and lack of consensus regarding antiplatelet management for carotid stent placement in the setting of endovascular stroke treatment. We aimed to develop a consensus-based algorithm for antiplatelet management in acute ischemic stroke patients undergoing endovascular treatment and simultaneous emergent carotid stent placement. MATERIALS AND METHODS: We performed a literature search and a modified Delphi approach used Web-based questionnaires that were sent in several iterations to an international multidisciplinary panel of 19 neurointerventionalists from 7 countries. The first round included open-ended questions and formed the basis for subsequent rounds, in which closed-ended questions were used. Participants continuously received feedback on the results from previous rounds. Consensus was defined as agreement of $70% for binary questions and agreement of $50% for questions with.2 answer options. The results of the Delphi process were then summarized in a draft manuscript that was circulated among the panel members for feedback. RESULTS: A total of 5 Delphi rounds were performed. Panel members preferred a single intravenous aspirin bolus or, in jurisdictions in which intravenous aspirin is not available, a glycoprotein IIb/IIIa receptor inhibitor as intraprocedural antiplatelet regimen and a combination therapy of oral aspirin and a P2Y12 inhibitor in the postprocedural period. There was no consensus on the role of platelet function testing in the postprocedural period. CONCLUSIONS: More and better data on antiplatelet management for carotid stent placement in the setting of endovascular treatment are urgently needed. Panel members preferred intravenous aspirin or, alternatively, a glycoprotein IIb/IIIa receptor inhibitor as an intraprocedural antiplatelet agent, followed by a dual oral regimen of aspirin and a P2Y12 inhibitor in the postprocedural period.
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U2 - 10.3174/ajnr.A6888
DO - 10.3174/ajnr.A6888
M3 - Article
C2 - 33122218
AN - SCOPUS:85097826609
SN - 0195-6108
VL - 41
SP - 2274
EP - 2279
JO - American Journal of Neuroradiology
JF - American Journal of Neuroradiology
IS - 12
ER -