Optimal periprocedural antithrombotic treatment in carotid interventions: An international, multispecialty, expert review and position statement

An international, multispecialty, expert-based Delphi Consensus document on controversial issues in the management of patients with asymptomatic and symptomatic carotid stenosis

“…47 Along the same lines, a recent international, multispecialty, expert review and position statement concluded that a short course (<3 months) of DAPT should be initiated within 24 hours of a cerebrovascular event in patients with carotid artery stenosis to reduce the risk of recurrent events. 48 A similar recommendation was provided in the 2021 AHA/ASA Guidelines. 5 In patients undergoing TCAR or transfemoral CAS, patients should continue with DAPT for 1 month, after which a P2Y12 inhibitor monotherapy should be continued.…”

“…5 In patients undergoing TCAR or transfemoral CAS, patients should continue with DAPT for 1 month, after which a P2Y12 inhibitor monotherapy should be continued. 48 As a result of the conflicting data from the literature, a consensus on this topic could not be reached among the Delphi participants, although two-thirds of the experts thought that DAPT is certainly (33 of 61; 54.1%) or probably/possibly (8 of 61; 13.2%) safe and effective in reducing perioperative thromboembolic events (Supplementary Table II, online only).…”

Rescue of immediate post-transcarotid artery revascularization carotid stent thrombosis due to clopidogrel resistance using flow-reversal and aspiration thrombectomy

“… 25 , 26 , 27 Preoperative testing for clopidogrel resistance via functional, TEG, or genetic testing is not currently universally recommended. 3 However, until ticagrelor becomes a first-line recommendation for carotid artery stenting (as it has for cardiac stenting), testing for clopidogrel resistance should be considered.…”

“… 2 Antiplatelet regimens have been derived from cardiology literature, and clopidogrel resistance has been well-documented. 1 , 2 , 3 Previously an alternative therapy, ticagrelor is now a first-line treatment in cardiology guidelines owing to the lower incidence of resistance. 3 A new intravenous P2Y12 inhibitor, cangrelor, has been used successfully as a bridging agent in recent multidisciplinary studies.…”

“… 1 , 2 , 3 Previously an alternative therapy, ticagrelor is now a first-line treatment in cardiology guidelines owing to the lower incidence of resistance. 3 A new intravenous P2Y12 inhibitor, cangrelor, has been used successfully as a bridging agent in recent multidisciplinary studies. 4 , 5 , 6 , 7 Even with TCAR developed to increase the safety and accessibility of carotid interventions for the high-risk population, early ACST remains an acute concern.…”