Related Experiment Video
Updated: Aug 9, 2025
Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Physician Approaches to Antithrombotic Therapies for Recently Symptomatic Carotid Stenosis
Aravind Ganesh1,2,3, Benjamin Beland1, Gordon A E Jewett1,3
1Calgary Stroke Program, Department of Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada.
Insights
Stroke physicians have varied approaches to managing symptomatic carotid stenosis due to limited evidence. Key uncertainties involve antiplatelet therapy choices and timing, especially before revascularization.
Area of Science:
- Neurology
- Vascular Surgery
- Interventional Neuroradiology
Background:
- Established benefit of antiplatelet therapy for stroke prevention.
- Uncertainty exists regarding optimal antithrombotic strategies for symptomatic carotid stenosis.
Purpose of the Study:
- To explore stroke physicians' decision-making processes for antithrombotic management in symptomatic carotid stenosis.
- To understand current practices and identify areas of uncertainty in treatment.
Main Methods:
- Qualitative descriptive study using semi-structured interviews.
- 22 stroke physicians from 16 international centers participated.
- Thematic analysis of interview transcripts was performed.
Main Results:
- Key themes include limited clinical trial data, differing preferences between surgeons and physicians, and antiplatelet choices before revascularization.
- Concerns about adverse events with dual-antiplatelet therapy (DAPT) were higher for carotid endarterectomy than stenting.
- Regional variations in practice (e.g., single antiplatelet use in Europe) and numerous areas of uncertainty were identified.
Conclusions:
- Findings encourage critical examination of antithrombotic approaches for symptomatic carotid stenosis.
- Future trials should address practice variations and uncertainties to guide clinical decisions.
Background:
Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention has been well established, uncertainties remain regarding the optimal antithrombotic regimen for recently symptomatic carotid stenosis. We sought to explore the approaches of stroke physicians to antithrombotic management of patients with symptomatic carotid stenosis.
Methods:
We employed a qualitative descriptive methodology to explore the decision-making approaches and opinions of physicians regarding antithrombotic regimens for symptomatic carotid stenosis. We conducted semi-structured interviews with a purposive sample of 22 stroke physicians (11 neurologists, 3 geriatricians, 5 interventional-neuroradiologists, and 3 neurosurgeons) from 16 centers on four continents to discuss symptomatic carotid stenosis management. We then conducted thematic analysis on the transcripts.
Results:
Important themes revealed from our analysis included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences, and the choice of antiplatelet therapy while awaiting revascularization. There was a greater concern for adverse events while using multiple antiplatelet agents (e.g., dual-antiplatelet therapy (DAPT)) in patients undergoing carotid endarterectomy compared to carotid artery stenting. Regional variations included more frequent use of single antiplatelet agents among European participants. Areas of uncertainty included antithrombotic management if already on an antiplatelet agent, implications of nonstenotic features of carotid disease, the role of newer antiplatelet agents or anticoagulants, platelet aggregation testing, and timing of DAPT.
Conclusion:
Our qualitative findings can help physicians critically examine the rationale underlying their own antithrombotic approaches to symptomatic carotid stenosis. Future clinical trials may wish to accommodate identified variations in practice patterns and areas of uncertainty to better inform clinical practice.
Related Concept Videos
01:27Coronary Artery Disease V: Interprofessional Care
01:26Atherosclerosis III: Management
01:27Peripheral Artery Disease III: Interprofessional Care
01:26Angina IV: Management
01:29Venous Thrombosis III: Interprofessional Care
01:23Atherosclerosis IV: Nursing Management