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

Research output: Contribution to journalArticlepeer-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 languageEnglish (US)
Pages (from-to)627-632
Number of pages6
JournalNeuroradiology
Volume63
Issue number4
DOIs
StatePublished - 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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