Antithrombotic therapies for neurointerventional surgery: a 2021 French comprehensive national survey

Abstract

BackgroundNeurointerventionists lack guidelines for the use of antithrombotic therapies in their clinical practice; consequently, there is likely to be significant heterogeneity in antithrombotic use between centers. Through a nationwide survey, we aimed to obtain an exhaustive cross-sectional overview of antithrombotic use in neurointerventional procedures in France.MethodsIn April 2021, French neurointerventional surgery centers were invited to participate in a nationwide 51-question survey disseminated through an active trainee-led research collaborative network (the JENI-RC).ResultsAll 40 centers answered the survey. Fifty-one percent of centers reported using ticagrelor and 43% used clopidogrel as premedication before intracranial stenting. For flow diversion treatment, dual antiplatelet therapy was maintained for 3 or 6 months in 39% and 53% of centers, respectively, and aspirin was prescribed for 12 months or more than 12 months in 63% and 26% of centers, respectively. For unruptured aneurysms, the most common heparin bolus dose was 50 IU/kg (59%), and only 35% of centers monitored heparin activity for dose adjustment. Tirofiban was used in 64% of centers to treat thromboembolic complications. Fifteen percent of these comprehensive stroke centers reported using tenecteplase to treat acute ischemic strokes. Cangrelor appeared as an emergent drug in specific indications.ConclusionThis nationwide survey highlights the important heterogeneity in clinical practices across centers. There is a pressing need for trials and guidelines to further evaluate and harmonize antithrombotic regimens in the neurointerventional field.

24-Hour Carotid Stent Patency and Outcomes After Endovascular Therapy: A Multicenter Study

“…A stent occlusion was observed in 47/225 patients (20.9%). Patients with stent patency had a lower baseline National Institutes of Health Stroke Scale (median [interquartile range]: 13 [7-17] versus 18 [12][13][14][15][16][17][18][19][20][21]) and had more often stroke of atherothrombotic origin (77.0% versus 53.2%). A higher stent patency rate was found for patients treated with P2Y 12 antagonists at the acute phase (odds ratio [OR]‚ 2.95 [95% CI‚ 1.10-7.91]; P=0.026) and treated with angioplasty (OR‚ 2.42 [95% CI‚ 1.24-4.67]; P=0.008).…”

“…Baseline characteristics are reported in Table 1 according to the stent patency within 24 (±12) hours. Compared with the patients with stent occlusion, patients with stent patency had a lower stroke severity assessed by pre-treatment NIHSS score (median [interquartile range]: 13 [7][8][9][10][11][12][13][14][15][16][17] versus 18 [12][13][14][15][16][17][18][19][20][21]) and had more often a stroke of atherothrombotic origin (77.0% versus 53.2%).…”

“…This heterogeneity was recently highlighted in a French nationwide survey. 13 Trials are needed to evaluate the optimal antiplatelet strategy. Small series reported a good safety profile of Cangrelor used during emergent CAS, [14][15][16][17] especially when compared with GpIIb/IIIa inhibitors.…”

Perioperative Antiplatelet Therapy for the Stent-Assisted Coil Embolization: Results of the Questionnaire Survey

“…10) Multiple reports have been made on postoperative antiplatelet therapy in the neurointerventional field. 4,[11][12][13][14] These studies have demonstrated the importance of postoperative platelet function tests. Kim et al examined the optimal duration of postoperative DAPT.…”

A pressing need and opportunity to standardize care in neurointerventional surgery

“…However, current practice is highly variable and cardiovascular pathophysiology is significantly different from that in the neurovascular space. This phenomenon of wide variability was well demonstrated in a recent paper in the Journal of Neurointerventional Surgery by Caroff et al 1. The authors leveraged JENI (Jeunes en Neuroradiologie Interventionelle), a large network of in training and early career neurointerventionalists in France, and conducted a comprehensive nationwide survey obtaining a cross sectional overview of antithrombotic use in neurointerventional procedures.…”