M Goyal1,2, S Yoshimura3, G Milot4, J Fiehler5, M Jayaraman6, F Dorn7, A Taylor8, J Liu9, F Albuquerque10, M E Jensen11, R Nogueira12,13, J F Fraser14, R Chapot15, L Thibault16, C Majoie17, P Yang9, N Sakai18, D Kallmes19, K Orlov20, A Arthur21, P Brouwer22,23, J M Ospel24,25. 1. From the Departments of Clinical Neurosciences (M.G., J.M.O.) mgoyal@ucalgary.ca. 2. Diagnostic Imaging (M.G.), University of Calgary, Calgary, Alberta, Canada. 3. Department of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan. 4. Department of Neurosurgery (G.M.), Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada. 5. Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 6. Departments of Diagnostic Imaging, Neurology, and Neurosurgery (M.J.), Warren Alpert School of Medicine at Brown University, Providence, Rhode Island. 7. Institute of Neuroradiology (F.D.), University of Munich, Ludwig-Maximilians-Universität, Munich, Germany. 8. Groote Schuur Hospital (A.T.), University of Cape Town, Cape Town, South Africa. 9. Department of Neurosurgery (J.L., P.Y.), Changhai Hospital Naval Medical University, Shanghai, China. 10. Department of Neurosurgery (F.A.), Barrow Neurological Institute, Phoenix, Arizona. 11. Departments of Neurological Surgery, Radiology, and Medical Imaging (M.E.J.), University of Virginia Health, Charlottesville, Virginia. 12. Marcus Stroke & Neuroscience Center (R.N.), Grady Memorial Hospital, Atlanta, Georgia. 13. Department of Neurology (R.N.), Emory University School of Medicine, Atlanta, Georgia. 14. Departments of Neurosurgery (J.F.F.), Neurology, Radiology, and Neuroscience. University of Kentucky, Lexington, Kentucky. 15. Department of Neuroradiology (R.C.), Alfred Krupp Krankenhaus Essen, Essen, Germany. 16. Member of the Scientific Committee (L.T.), World Federation of Interventional and Therapeutic Neuroradiology, Paris, France. 17. Department of Radiology (C.M.), Academic Medical Center, Amsterdam, the Netherlands. 18. Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan. 19. Department of Radiology (D.K.), Mayo Clinic, Rochester, Minnesota. 20. Meshalkin National Medical Research Center (K.O.), Novosibirsk, Russian Federation. 21. Department of Neurosurgery (A.A.), Semmes-Murphey Clinic/University of Tennessee, Memphis, Tennessee. 22. Department of Interventional Neuroradiology (P.B.), Karolinksa Hospital, Stockholm, Sweden. 23. University NeuroVascular Center (P.B.), University Medical Center, Haaglanden Medical Center, Leiden, the Netherlands. 24. From the Departments of Clinical Neurosciences (M.G., J.M.O.). 25. Department of Neuroradiology (J.M.O.), University Hospital of Basel, Basel, Switzerland.
Abstract
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.
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 strokepatients 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.
Authors: Robin J Borchert; Davide Simonato; Charlotte R Hickman; Maurizio Fuschi; Lucie Thibault; Hans Henkes; David Fiorella; Benjamin Yq Tan; Leonard Ll Yeo; Hegoda L D Makalanda; Ken Wong; Pervinder Bhogal Journal: Interv Neuroradiol Date: 2021-05-04 Impact factor: 1.610