Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement
| Autor: | Mahesh V Jayaraman, Johanna M. Ospel, René Chapot, L. Thibault, Mary E. Jensen, Felipe C. Albuquerque, Justin F. Fraser, Jens Fiehler, Allan Taylor, Charles B. L. M. Majoie, K. Orlov, Raul G Nogueira, Mayank Goyal, Patrick A. Brouwer, Nobuyuki Sakai, Adam S Arthur, David F. Kallmes, F. Dorn, Jianmin Liu |
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| Přispěvatelé: | Radiology and Nuclear Medicine, ACS - Microcirculation, ANS - Neurovascular Disorders, ACS - Atherosclerosis & ischemic syndromes |
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Consensus Delphi Technique MEDLINE Modified delphi Aneurysm Ruptured Stent assisted coiling 030218 nuclear medicine & medical imaging 03 medical and health sciences 0302 clinical medicine medicine Humans Radiology Nuclear Medicine and imaging cardiovascular diseases Neuroradiology Retrospective Studies Aspirin Flow diversion business.industry General surgery Endovascular Procedures Intracranial Aneurysm Middle Aged medicine.disease Embolization Therapeutic Hydrocephalus Regimen Female Stents Neurology (clinical) Intracranial Thrombosis Erratum business 030217 neurology & neurosurgery Platelet Aggregation Inhibitors medicine.drug |
| Zdroj: | AJNR Am J Neuroradiol American Journal of Neuroradiology, 41(10), 1856-1862. AMER SOC NEURORADIOLOGY AJNR. American journal of neuroradiology, 41(10), 1856-1862. American Society of Neuroradiology |
| ISSN: | 1936-959X 0195-6108 |
| Popis: | BACKGROUND AND PURPOSE: There is a paucity of data regarding antiplatelet management strategies in the setting of stent-assisted coiling/flow diversion for ruptured intracranial aneurysms. This study aimed to identify current challenges in antiplatelet management during stent-assisted coiling/flow diversion for ruptured intracranial aneurysms and to outline possible antiplatelet management strategies. MATERIALS AND METHODS: The modified DELPHI approach with an on-line questionnaire was sent in several iterations to an international, multidisciplinary panel of 15 neurointerventionalists. The first round consisted of open-ended questions, followed by closed-ended questions in the subsequent rounds. Responses were analyzed in an anonymous fashion and summarized in the final manuscript draft. The statement received endorsement from the World Federation of Interventional and Therapeutic Neuroradiology, the Japanese Society for Neuroendovascular Therapy, and the Chinese Neurosurgical Society. RESULTS: Data were collected from December 9, 2019, to March 13, 2020. Panel members achieved consensus that platelet function testing may not be necessary and that antiplatelet management for stent-assisted coiling and flow diversion of ruptured intracranial aneurysms can follow the same principles. Preprocedural placement of a ventricular drain was thought to be beneficial in cases with a high risk of hydrocephalus. A periprocedural dual, intravenous, antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor was preferred as a standard approach. The panel agreed that intravenous medication can be converted to oral aspirin and an oral P2Y12 inhibitor within 24 hours after the procedure. CONCLUSIONS: More and better data on antiplatelet management of patients with ruptured intracranial aneurysms undergoing stent-assisted coiling or flow diversion are urgently needed. Panel members in this DELPHI consensus study preferred a periprocedural dual-antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor. |
| Databáze: | OpenAIRE |
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