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Heterogeneous practice patterns regarding antiplatelet medications for neuroendovascular stenting in the USA: a multicenter survey.

Abstract：

BACKGROUND:Adequate dual antiplatelet (AP) therapy is imperative when performing neurovascular stenting procedures. Currently, no consensus for the ideal AP regimen exists. Thus the present study aimed to gain a better understanding of real world practice AP patterns by surveying neurointerventional surgeons. METHODS:Survey links were emailed to 296 neurointerventional surgeons practicing in the USA, asking 51 questions including demographics, stent specific use, AP pre and post-medication, types of APs, point of care (POC) assessment, complications, and outcomes. Data were collected and analyzed using Research Electronic Data Capture (REDCap). RESULTS:74 participants responded; 56.8% were from academic centers. Participants treated an average of 5.5 aneurysms per month. They placed an average of 1.6 intracranial stents and 1.4 cervical stents per month. Mean number of pipeline embolization devices (PEDs) placed per year was 15.2. Heterogeneity existed regarding AP regimens; the most frequent included acetylsalicylic acid (ASA) 325 mg+Plavix 75 mg daily (for 7 days prior) and ASA 325 mg+Plavix 75 mg daily (for 5 days prior) for routine placement of intracranial and cervical stents, respectively. For emergency placement, ASA 325 mg+Plavix 600 mg (at time of surgery) was the most frequently used. 46.8% routinely used POC testing, most frequently VerifyNow (Accumetrics, San Diego, California, USA); the most common threshold determining a non-responder was <30% inhibition. 85.7% used POC for PED placement. Management changes based on POC testing were diverse. CONCLUSIONS:The results highlight the heterogeneity of current practices regarding AP medication regimens during neurovascular stenting. Given its importance, evidence based protocols are imperative. Minimal literature exists focusing on neurovasculature, and therefore understanding current practice patterns represents a first step toward generating these protocols.

journal_name

J Neurointerv Surg

journal_title

Journal of neurointerventional surgery

authors

Faught RW,Satti SR,Hurst RW,Pukenas BA,Smith MJ

doi

10.1136/neurintsurg-2013-010954

subject

Has Abstract

pub_date

2014-12-01 00:00:00

pages

774-9

issue

eissn

1759-8478

issn

1759-8486

pii

neurintsurg-2013-010954

journal_volume

pub_type

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Heterogeneous practice patterns regarding antiplatelet medications for neuroendovascular stenting in the USA: a multicenter survey.