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Optimal periprocedural antithrombotic treatment in carotid interventions: An international, multispecialty, expert

Kosmas I Paraskevas1, Peter Gloviczki2, Dimitri P Mikhailidis3

  • 1Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece.

Progress in Cardiovascular Diseases
|October 20, 2022
PubMed

Insights

Optimal antithrombotic therapy for carotid artery interventions varies. For asymptomatic patients, single antiplatelets are recommended. Symptomatic patients benefit from dual antiplatelet treatment (DAPT) post-procedure, with individualized long-term strategies.

Area of Science:

  • Vascular Surgery
  • Cardiology
  • Pharmacology

Background:

  • Debate exists regarding optimal antithrombotic treatment for extracranial carotid artery interventions.
  • Current guidelines require critical review in light of recent research.

Purpose of the Study:

  • To critically review current guidelines on antithrombotic therapy for carotid interventions.
  • To formulate evidence-based recommendations for asymptomatic and symptomatic patients.

Main Methods:

  • Multidisciplinary expert panel review of antithrombotic strategies.
  • Evaluation of treatments for endarterectomy, transfemoral carotid artery stenting (CAS), and transcarotid artery revascularization (TCAR).

Main Results:

  • Asymptomatic patients: low-dose aspirin or clopidogrel recommended to reduce cardiovascular events.
  • Symptomatic patients: dual antiplatelet treatment (DAPT) initiated within 24 hours to prevent recurrent events.
  • Post-CAS/TCAR: DAPT for 1 month, then single antiplatelet; no strong evidence for anticoagulation.

Conclusions:

  • Individualize antithrombotic treatment based on symptoms, intervention type, and treatment goals.
  • Future trials should investigate DAPT duration and agents like ticagrelor.
Abstract

Keywords:
Antithrombotic treatmentAspirinCarotid artery stentingCarotid endarterectomyClopidogrelStrokeTCAR

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