Mayank Goyal1, Kirill Orlov2, Mary E Jensen3, Allan Taylor4, Charles Majoie5, Mahesh Jayaraman6, Jianmin Liu7, Geneviève Milot8, Patrick Brouwer9,10, Shinichi Yoshimura11, Felipe Albuquerque12, Adam Arthur13, David Kallmes14, Nobuyuki Sakai15, Justin F Fraser16, Raul Nogueira17, Pengfei Yang7, Franziska Dorn18, Lucie Thibault19, Jens Fiehler20, René Chapot21, Johanna Maria Ospel22,23. 1. Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada. mgoyal@ucalgary.ca. 2. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation. 3. Departments of Neurological Surgery, Radiology and Medical Imaging, UVA Health, Charlottesville, VA, USA. 4. Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa. 5. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, location AMC, Amsterdam, The Netherlands. 6. Departments of Diagnostic Imaging, Neurology and Neurosurgery Warren Alpert School of Medicine at Brown University, Providence, RI, USA. 7. Department of Neurosurgery, Changhai Hospital Naval Medical University, Shanghai, China. 8. Department of Neurosurgery, CHU de Québec, Quebec City, Canada. 9. Department of Interventional Neuroradiology, Karolinksa Hospital, Stockholm, Sweden. 10. University NeuroVascular Center 'UNVC', Leiden University Medical Center, Haaglanden Medical Center, Leiden, Netherlands. 11. Department of Neurosurgery, Hyogo College of Medicine 1-1 Mukogawa, Nishinomiya, Hyogo, Japan. 12. Department of Neurosurgery, Barrow Neurological Institute, Phoenix, USA. 13. Department of Neurosurgery, Semmes-Murphey Clinic/ University of TN, Memphis, TN, USA. 14. Department of Radiology, Mayo Clinic, Rochester, USA. 15. Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan. 16. Departments of Neurosurgery, Neurology, Radiology, and Neuroscience, University of Kentucky, Lexington, KY, USA. 17. Marcus Stroke & Neuroscience Center, Grady Memorial Hospital and Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA. 18. Department of Neuroradiology, University Hospital Bonn, Bonn, Germany. 19. WFITN, Paris, France. 20. Department of Diagnostic and Interventional Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 21. Department of Neuroradiology, Alfred Krupp Krankenhaus Essen, Essen, Germany. 22. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. 23. Department of Neuroradiology, University Hospital of Basel, Basel, Switzerland.
Abstract
PURPOSE: There is little data and lack of consensus regarding antiplatelet management for intracranial stenting due to underlying intracranial atherosclerosis in the setting of endovascular treatment (EVT). In this DELPHI study, we aimed to assess whether consensus on antiplatelet management in this situation among experienced experts can be achieved, and what this consensus would be. METHODS: We used a modified DELPHI approach to address unanswered questions in antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of EVT. An expert-panel (19 neurointerventionalists from 8 countries) answered structured, anonymized on-line questionnaires with iterative feedback-loops. Panel-consensus was defined as agreement ≥ 70% for binary closed-ended questions/≥ 50% for closed-ended questions with > 2 response options. RESULTS: Panel members answered a total of 5 survey rounds. They acknowledged that there is insufficient data for evidence-based recommendations in many aspects of antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of EVT. They believed that antiplatelet management should follow a standardized regimen, irrespective of imaging findings and reperfusion quality. There was no consensus on the timing of antiplatelet-therapy initiation. Aspirin was the preferred antiplatelet agent for the peri-procedural period, and oral Aspirin in combination with a P2Y12 inhibitor was the favored postprocedural regimen. CONCLUSION: Data on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of EVT are limited. Panel-members in this study achieved consensus on postprocedural antiplatelet management but did not agree upon a preprocedural and intraprocedural antiplatelet regimen. Further prospective studies to optimize antiplatelet regimens are needed.
PURPOSE: There is little data and lack of consensus regarding antiplatelet management for intracranial stenting due to underlying intracranial atherosclerosis in the setting of endovascular treatment (EVT). In this DELPHI study, we aimed to assess whether consensus on antiplatelet management in this situation among experienced experts can be achieved, and what this consensus would be. METHODS: We used a modified DELPHI approach to address unanswered questions in antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of EVT. An expert-panel (19 neurointerventionalists from 8 countries) answered structured, anonymized on-line questionnaires with iterative feedback-loops. Panel-consensus was defined as agreement ≥ 70% for binary closed-ended questions/≥ 50% for closed-ended questions with > 2 response options. RESULTS: Panel members answered a total of 5 survey rounds. They acknowledged that there is insufficient data for evidence-based recommendations in many aspects of antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of EVT. They believed that antiplatelet management should follow a standardized regimen, irrespective of imaging findings and reperfusion quality. There was no consensus on the timing of antiplatelet-therapy initiation. Aspirin was the preferred antiplatelet agent for the peri-procedural period, and oral Aspirin in combination with a P2Y12 inhibitor was the favored postprocedural regimen. CONCLUSION: Data on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of EVT are limited. Panel-members in this study achieved consensus on postprocedural antiplatelet management but did not agree upon a preprocedural and intraprocedural antiplatelet regimen. Further prospective studies to optimize antiplatelet regimens are needed.
Authors: H G Woo; L Sunwoo; C Jung; B J Kim; M-K Han; H-J Bae; Y J Bae; B S Choi; J H Kim Journal: AJNR Am J Neuroradiol Date: 2017-12-14 Impact factor: 3.825
Authors: B Gregory Thompson; Robert D Brown; Sepideh Amin-Hanjani; Joseph P Broderick; Kevin M Cockroft; E Sander Connolly; Gary R Duckwiler; Catherine C Harris; Virginia J Howard; S Claiborne Clay Johnston; Philip M Meyers; Andrew Molyneux; Christopher S Ogilvy; Andrew J Ringer; James Torner Journal: Stroke Date: 2015-06-18 Impact factor: 7.914
Authors: Nimer Adeeb; Christoph J Griessenauer; Paul M Foreman; Justin M Moore; Hussain Shallwani; Rouzbeh Motiei-Langroudi; Abdulrahman Alturki; Adnan H Siddiqui; Elad I Levy; Mark R Harrigan; Christopher S Ogilvy; Ajith J Thomas Journal: Stroke Date: 2017-04-14 Impact factor: 7.914
Authors: Massimo Filippi; Maria A Rocca; Olga Ciccarelli; Nicola De Stefano; Nikos Evangelou; Ludwig Kappos; Alex Rovira; Jaume Sastre-Garriga; Mar Tintorè; Jette L Frederiksen; Claudio Gasperini; Jacqueline Palace; Daniel S Reich; Brenda Banwell; Xavier Montalban; Frederik Barkhof Journal: Lancet Neurol Date: 2016-01-26 Impact factor: 44.182