Considerations for Antiplatelet Management of Carotid Stenting in the Setting of Mechanical Thrombectomy: A Delphi Consensus Statement

被引：27

作者：

Goyal, M. ^{[1
,2
]}

Yoshimura, S. ^{[3
]}

Milot, G. ^{[4
]}

Fiehler, J. ^{[5
]}

Jayaraman, M. ^{[6
,7
,8
]}

Dorn, F. ^{[9
]}

Taylor, A. ^{[10
]}

Liu, J. ^{[11
]}

Albuquerque, F. ^{[12
]}

Jensen, M. E. ^{[13
,14
,15
]}

Nogueira, R. ^{[16
,17
]}

Fraser, J. F. ^{[18
,19
,20
,21
]}

Chapot, R. ^{[22
]}

Thibault, L. ^{[23
]}

Majoie, C. ^{[24
]}

Yang, P. ^{[11
]}

Sakai, N. ^{[25
]}

Kallmes, D. ^{[26
]}

Orlov, K. ^{[27
]}

Arthur, A. ^{[28
]}

Brouwer, P. ^{[29
,30
]}

Ospel, J. M. ^{[1
,31
]}

机构：

[1] Univ Calgary, Dept Clin Neurosci, Calgary, AB, Canada

[2] Univ Calgary, Dept Imaging, Calgary, AB, Canada

[3] Hyogo Coll Med, Dept Neurosurg, Nishinomiya, Hyogo, Japan

[4] Ctr Hosp Univ Quebec, Dept Neurosurg, Quebec City, PQ, Canada

[5] Univ Med Ctr Hamburg Eppendorf, Dept Diagnost & Intervent Neuroradiol, Hamburg, Germany

[6] Brown Univ, Dept Diagnost Imaging, Warren Alpert Sch Med, Providence, RI 02912 USA

[7] Brown Univ, Dept Neurol, Warren Alpert Sch Med, Providence, RI 02912 USA

[8] Brown Univ, Dept Neurosurg, Warren Alpert Sch Med, Providence, RI 02912 USA

[9] Ludwig Maximilians Univ Munchen, Univ Munich, Inst Neuroradiol, Munich, Germany

[10] Univ Cape Town, Groote Schuur Hosp, Cape Town, South Africa

[11] Changhai Hosp Naval Med Univ, Dept Neurosurg, Shanghai, Peoples R China

[12] Barrow Neurol Inst, Dept Neurosurg, Phoenix, AZ 85013 USA

[13] Univ Virginia Hlth, Dept Neurol Surg, Charlottesville, VA USA

[14] Univ Virginia Hlth, Dept Radiol, Charlottesville, VA USA

[15] Univ Virginia Hlth, Dept Med Imaging, Charlottesville, VA USA

[16] Grady Mem Hosp, Marcus Stroke & Neurosci Ctr, Atlanta, GA USA

[17] Emory Univ, Sch Med, Dept Neurol, Atlanta, GA 30322 USA

[18] Univ Kentucky, Dept Neurosurg, Lexington, KY USA

[19] Univ Kentucky, Dept Neurol, Lexington, KY 40536 USA

[20] Univ Kentucky, Dept Radiol, Lexington, KY USA

[21] Univ Kentucky, Dept Neurosci, Lexington, KY USA

[22] Alfred Krupp Krankenhaus Essen, Dept Neuroradiol, Essen, Germany

[23] World Federat Intervent & Therapeut Neuroradiol, Sci Comm, Paris, France

[24] Acad Med Ctr, Dept Radiol, Amsterdam, Netherlands

[25] Kobe City Med Ctr Gen Hosp, Dept Neurosurg, Kobe, Hyogo, Japan

[26] Mayo Clin, Dept Radiol, Rochester, MN USA

[27] Meshalkin Natl Med Res Ctr, Novosibirsk, Russia

[28] Univ Tennessee, Dept Neurosurg, Semmes Murphey Clin, Memphis, TN USA

[29] Karolinksa Hosp, Dept Intervent Neuroradiol, Stockholm, Sweden

[30] Haaglanden Med Ctr, Univ Med Ctr, Univ NeuroVasc Ctr, Leiden, Netherlands

[31] Univ Hosp Basel, Dept Neuroradiol, Basel, Switzerland

来源：

AMERICAN JOURNAL OF NEURORADIOLOGY | 2020年 / 41卷 / 12期

关键词：

ACUTE ISCHEMIC-STROKE;

D O I：

10.3174/ajnr.A6888

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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.

引用

页码：2274 / 2279

页数：6

共 18 条

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