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Research ArticleNeurointervention

Considerations for Antiplatelet Management of Carotid Stenting in the Setting of Mechanical Thrombectomy: A Delphi Consensus Statement

M. Goyal, S. Yoshimura, G. Milot, J. Fiehler, M. Jayaraman, F. Dorn, A. Taylor, J. Liu, F. Albuquerque, M.E. Jensen, R. Nogueira, J.F. Fraser, R. Chapot, L. Thibault, C. Majoie, P. Yang, N. Sakai, D. Kallmes, K. Orlov, A. Arthur, P. Brouwer and J.M. Ospel
American Journal of Neuroradiology December 2020, 41 (12) 2274-2279; DOI: https://doi.org/10.3174/ajnr.A6888
M. Goyal
aFrom the Departments of Clinical Neurosciences (M.G., J.M.O.)
bDiagnostic Imaging (M.G.), University of Calgary, Calgary, Alberta, Canada
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S. Yoshimura
cDepartment of Neurosurgery (S.Y.), Hyogo College of Medicine, Nishinomiya, Hyogo, Japan
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G. Milot
dDepartment of Neurosurgery (G.M.), Centre Hospitalier Universitaire de Québec, Québec City, Québec, Canada
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J. Fiehler
eDepartment of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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M. Jayaraman
fDepartments of Diagnostic Imaging, Neurology, and Neurosurgery (M.J.), Warren Alpert School of Medicine at Brown University, Providence, Rhode Island
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F. Dorn
gInstitute of Neuroradiology (F.D.), University of Munich, Ludwig-Maximilians-Universität, Munich, Germany
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A. Taylor
hGroote Schuur Hospital (A.T.), University of Cape Town, Cape Town, South Africa
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J. Liu
iDepartment of Neurosurgery (J.L., P.Y.), Changhai Hospital Naval Medical University, Shanghai, China
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F. Albuquerque
jDepartment of Neurosurgery (F.A.), Barrow Neurological Institute, Phoenix, Arizona
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M.E. Jensen
kDepartments of Neurological Surgery, Radiology, and Medical Imaging (M.E.J.), University of Virginia Health, Charlottesville, Virginia
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R. Nogueira
lMarcus Stroke & Neuroscience Center (R.N.), Grady Memorial Hospital, Atlanta, Georgia
mDepartment of Neurology (R.N.), Emory University School of Medicine, Atlanta, Georgia
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J.F. Fraser
nDepartments of Neurosurgery (J.F.F.), Neurology, Radiology, and Neuroscience. University of Kentucky, Lexington, Kentucky
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R. Chapot
oDepartment of Neuroradiology (R.C.), Alfred Krupp Krankenhaus Essen, Essen, Germany
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L. Thibault
pMember of the Scientific Committee (L.T.), World Federation of Interventional and Therapeutic Neuroradiology, Paris, France
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C. Majoie
qDepartment of Radiology (C.M.), Academic Medical Center, Amsterdam, the Netherlands
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P. Yang
iDepartment of Neurosurgery (J.L., P.Y.), Changhai Hospital Naval Medical University, Shanghai, China
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N. Sakai
rDepartment of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan
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D. Kallmes
sDepartment of Radiology (D.K.), Mayo Clinic, Rochester, Minnesota
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K. Orlov
tMeshalkin National Medical Research Center (K.O.), Novosibirsk, Russian Federation
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A. Arthur
uDepartment of Neurosurgery (A.A.), Semmes-Murphey Clinic/University of Tennessee, Memphis, Tennessee
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P. Brouwer
vDepartment of Interventional Neuroradiology (P.B.), Karolinksa Hospital, Stockholm, Sweden
wUniversity NeuroVascular Center (P.B.), University Medical Center, Haaglanden Medical Center, Leiden, the Netherlands
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J.M. Ospel
aFrom the Departments of Clinical Neurosciences (M.G., J.M.O.)
xDepartment of Neuroradiology (J.M.O.), University Hospital of Basel, Basel, Switzerland
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    FIG 1.

    Delphi methodology as it was used in this article.

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    FIG 2.

    Summary of the results of the Delphi consensus panel. The asterisk means see Table 1 for dosages. Two asterisks mean see Table 2 for dosages.

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    Table 1:

    Consensus recommendations for the dosage of GPIIb/IIIa receptor inhibitorsa

    AgentTirofibanEptifibatideAbciximab
    Loading dose (IV or IA bolus)12 mcg/kg for 30 minb180 mcg/kg for 1–2 min0.25 mg/kg
    Maintenance dose (if necessary, IV infusion for 12–24 h)0.1 mcg/kg/min2 mcg/min125 mcg/kg/min
    Trade nameAggrastatIntegrilinReoPro
    Duration of antiplatelet effect4–8 h4 h48 h
    • Note:—IA indicates intra-arterial.

    • ↵a Dosages are suggestions based on the panel consensus and may vary according to local availability of dosages.

    • ↵b 0.4 mcg/kg/min.

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    Table 2:

    Consensus recommendations for dosing of oral P2Y12 inhibitors in the postprocedural perioda

    AgentClopidogrelTicagrelorPrasugrel
    Loading doseb600 mg180 mg40–60 mg
    Maintenance dose75 mg daily60–90 mg 2×/day5–10 mg daily
    Trade namePlavixBrilinta/BriliqueEffient
    Onset of action2 h30 min15–30 min
    • ↵a Dosages are suggestions based on the panel consensus and may vary according to local availability of dosages.

    • ↵b If deemed necessary.

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American Journal of Neuroradiology: 41 (12)
American Journal of Neuroradiology
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Cite this article
M. Goyal, S. Yoshimura, G. Milot, J. Fiehler, M. Jayaraman, F. Dorn, A. Taylor, J. Liu, F. Albuquerque, M.E. Jensen, R. Nogueira, J.F. Fraser, R. Chapot, L. Thibault, C. Majoie, P. Yang, N. Sakai, D. Kallmes, K. Orlov, A. Arthur, P. Brouwer, J.M. Ospel
Considerations for Antiplatelet Management of Carotid Stenting in the Setting of Mechanical Thrombectomy: A Delphi Consensus Statement
American Journal of Neuroradiology Dec 2020, 41 (12) 2274-2279; DOI: 10.3174/ajnr.A6888

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Considerations for Antiplatelet Management of Carotid Stenting in the Setting of Mechanical Thrombectomy: A Delphi Consensus Statement
M. Goyal, S. Yoshimura, G. Milot, J. Fiehler, M. Jayaraman, F. Dorn, A. Taylor, J. Liu, F. Albuquerque, M.E. Jensen, R. Nogueira, J.F. Fraser, R. Chapot, L. Thibault, C. Majoie, P. Yang, N. Sakai, D. Kallmes, K. Orlov, A. Arthur, P. Brouwer, J.M. Ospel
American Journal of Neuroradiology Dec 2020, 41 (12) 2274-2279; DOI: 10.3174/ajnr.A6888
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