PT  - JOURNAL ARTICLE
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.
TI  - Considerations for Antiplatelet Management of Carotid Stenting in the Setting of Mechanical Thrombectomy: A Delphi Consensus Statement
AID  - 10.3174/ajnr.A6888
DP  - 2020 Dec 01
TA  - American Journal of Neuroradiology
PG  - 2274--2279
VI  - 41
IP  - 12
4099  - http://www.ajnr.org/content/41/12/2274.short
4100  - http://www.ajnr.org/content/41/12/2274.full
SO  - Am. J. Neuroradiol.2020 Dec 01; 41
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.EVTendovascular treatmentGPIIb/IIIaglycoprotein IIb/IIIa