A DELPHI consensus statement on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of mechanical thrombectomy

Mayank Goyal; Kirill Orlov; Mary E. Jensen; Allan Taylor; Charles Majoie; Mahesh Jayaraman; Jianmin Liu; Geneviève Milot; Patrick Brouwer; Shinichi Yoshimura; Felipe Albuquerque; Adam Arthur; David Kallmes; Nobuyuki Sakai; Justin F. Fraser; Raul Nogueira; Pengfei Yang; Franziska Dorn; Lucie Thibault; Jens Fiehler; René Chapot; Johanna Maria Ospel

doi:10.1007/s00234-020-02556-z

A DELPHI consensus statement on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of mechanical thrombectomy

Mayank Goyal, Kirill Orlov, Mary E. Jensen, Allan Taylor, Charles Majoie, Mahesh Jayaraman, Jianmin Liu, Geneviève Milot, Patrick Brouwer, Shinichi Yoshimura, Felipe Albuquerque, Adam Arthur, David Kallmes, Nobuyuki Sakai, Justin F. Fraser, Raul Nogueira, Pengfei Yang, Franziska Dorn, Lucie Thibault, Jens FiehlerRené Chapot, Johanna Maria Ospel

Radiology

Research output: Contribution to journal › Article › peer-review

1 Scopus citations

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.

Original language	English (US)
Pages (from-to)	627-632
Number of pages	6
Journal	Neuroradiology
Volume	63
Issue number	4
DOIs	https://doi.org/10.1007/s00234-020-02556-z
State	Published - Apr 2021

Keywords

Angiography
Intracranial atherosclerosis
Intracranial stenting
Ischemic stroke

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging
Clinical Neurology
Cardiology and Cardiovascular Medicine

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10.1007/s00234-020-02556-z

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Goyal, M., Orlov, K., Jensen, M. E., Taylor, A., Majoie, C., Jayaraman, M., Liu, J., Milot, G., Brouwer, P., Yoshimura, S., Albuquerque, F., Arthur, A., Kallmes, D., Sakai, N., Fraser, J. F., Nogueira, R., Yang, P., Dorn, F., Thibault, L., ... Ospel, J. M. (2021). A DELPHI consensus statement on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of mechanical thrombectomy. Neuroradiology, 63(4), 627-632. https://doi.org/10.1007/s00234-020-02556-z

Goyal, M, Orlov, K, Jensen, ME, Taylor, A, Majoie, C, Jayaraman, M, Liu, J, Milot, G, Brouwer, P, Yoshimura, S, Albuquerque, F, Arthur, A, Kallmes, D, Sakai, N, Fraser, JF, Nogueira, R, Yang, P, Dorn, F, Thibault, L, Fiehler, J, Chapot, R & Ospel, JM 2021, 'A DELPHI consensus statement on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of mechanical thrombectomy', Neuroradiology, vol. 63, no. 4, pp. 627-632. https://doi.org/10.1007/s00234-020-02556-z

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title = "A DELPHI consensus statement on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of mechanical thrombectomy",

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.",

keywords = "Angiography, Intracranial atherosclerosis, Intracranial stenting, Ischemic stroke",

author = "Mayank Goyal and Kirill Orlov and Jensen, {Mary E.} and Allan Taylor and Charles Majoie and Mahesh Jayaraman and Jianmin Liu and Genevi{\`e}ve Milot and Patrick Brouwer and Shinichi Yoshimura and Felipe Albuquerque and Adam Arthur and David Kallmes and Nobuyuki Sakai and Fraser, {Justin F.} and Raul Nogueira and Pengfei Yang and Franziska Dorn and Lucie Thibault and Jens Fiehler and Ren{\'e} Chapot and Ospel, {Johanna Maria}",

note = "Publisher Copyright: {\textcopyright} 2020, Springer-Verlag GmbH Germany, part of Springer Nature.",

year = "2021",

month = apr,

doi = "10.1007/s00234-020-02556-z",

language = "English (US)",

volume = "63",

pages = "627--632",

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T1 - A DELPHI consensus statement on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of mechanical thrombectomy

AU - Goyal, Mayank

AU - Orlov, Kirill

AU - Jensen, Mary E.

AU - Taylor, Allan

AU - Majoie, Charles

AU - Jayaraman, Mahesh

AU - Liu, Jianmin

AU - Milot, Geneviève

AU - Brouwer, Patrick

AU - Yoshimura, Shinichi

AU - Albuquerque, Felipe

AU - Arthur, Adam

AU - Kallmes, David

AU - Sakai, Nobuyuki

AU - Fraser, Justin F.

AU - Nogueira, Raul

AU - Yang, Pengfei

AU - Dorn, Franziska

AU - Thibault, Lucie

AU - Fiehler, Jens

AU - Chapot, René

AU - Ospel, Johanna Maria

PY - 2021/4

Y1 - 2021/4

N2 - 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.

AB - 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.

KW - Angiography

KW - Intracranial atherosclerosis

KW - Intracranial stenting

KW - Ischemic stroke

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A DELPHI consensus statement on antiplatelet management for intracranial stenting due to underlying atherosclerosis in the setting of mechanical thrombectomy

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Keywords

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