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Considerations for Antiplatelet Management of Carotid Stenting in the Setting of Mechanical Thrombectomy: A Delphi Consensus Statement.
- Source :
-
AJNR. American journal of neuroradiology [AJNR Am J Neuroradiol] 2020 Dec; Vol. 41 (12), pp. 2274-2279. Date of Electronic Publication: 2020 Oct 29. - Publication Year :
- 2020
-
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.<br />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.<br />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.<br />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.<br /> (© 2020 by American Journal of Neuroradiology.)
Details
- Language :
- English
- ISSN :
- 1936-959X
- Volume :
- 41
- Issue :
- 12
- Database :
- MEDLINE
- Journal :
- AJNR. American journal of neuroradiology
- Publication Type :
- Academic Journal
- Accession number :
- 33122218
- Full Text :
- https://doi.org/10.3174/ajnr.A6888