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A DELPHI consensus statement on antiplatelet management for intracranial stenting due to underlying atherosclerosis

Mayank Goyal1, Kirill Orlov2, Mary E Jensen3

  • 1Departments of Radiology and Clinical Neurosciences, Foothills Medical Centre, University of Calgary, 1403 29th St. NW, Calgary, AB, T2N2T9, Canada. mgoyal@ucalgary.ca.

Neuroradiology
|September 25, 2020
PubMed

Insights

Experts reached consensus on post-procedure antiplatelet therapy for intracranial stenting in atherosclerosis, favoring aspirin and a P2Y12 inhibitor. However, pre- and intra-procedure management lacked agreement, highlighting the need for further research on optimal antiplatelet regimens.

Area of Science:

  • Neurology
  • Interventional Neuroradiology
  • Cardiology

Background:

  • Intracranial stenting for atherosclerosis lacks consensus on antiplatelet management.
  • Endovascular treatment (EVT) for intracranial atherosclerosis presents unique challenges for antiplatelet strategies.

Purpose of the Study:

  • To achieve expert consensus on antiplatelet management for intracranial stenting in atherosclerosis during EVT.
  • To identify areas of agreement and disagreement among neurointerventionalists regarding antiplatelet regimens.

Main Methods:

  • Modified DELPHI approach utilized with an international expert panel (19 neurointerventionalists).
  • Anonymized online questionnaires with iterative feedback loops were employed over 5 survey rounds.
  • Consensus defined as ≥70% agreement for binary questions and ≥50% for multi-option questions.

Main Results:

  • Experts acknowledged insufficient data for evidence-based recommendations in many aspects.
  • A standardized regimen was preferred irrespective of imaging or reperfusion quality.
  • Consensus was achieved on postprocedural therapy (aspirin plus P2Y12 inhibitor), but not on pre- and intraprocedural timing or agents.

Conclusions:

  • Limited data exists for antiplatelet management in intracranial stenting for atherosclerosis.
  • Postprocedural antiplatelet management achieved expert consensus, but pre- and intraprocedural strategies did not.
  • Prospective studies are necessary to optimize antiplatelet regimens for these procedures.
Abstract

Keywords:
AngiographyIntracranial atherosclerosisIntracranial stentingIschemic stroke

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