考虑在机械取栓的情况下对颈动脉支架置入术进行抗血小板管理：德尔菲共识声明。
Considerations for Antiplatelet Management of Carotid Stenting in the Setting of Mechanical Thrombectomy: A Delphi Consensus Statement.
机构信息
From the Departments of Clinical Neurosciences (M.G., J.M.O.)
Diagnostic Imaging (M.G.), University of Calgary, Calgary, Alberta, Canada.
出版信息
AJNR Am J Neuroradiol. 2020 Dec;41(12):2274-2279. doi: 10.3174/ajnr.A6888. Epub 2020 Oct 29.
BACKGROUND AND PURPOSE
There are only few data and lack of consensus regarding antiplatelet management for carotid stent placement in the setting of endovascular stroke treatment. We aimed to develop a consensus-based algorithm for antiplatelet management in acute ischemic stroke patients undergoing endovascular treatment and simultaneous emergent carotid stent placement.
MATERIALS AND METHODS
We performed a literature search and a modified Delphi approach used Web-based questionnaires that were sent in several iterations to an international multidisciplinary panel of 19 neurointerventionalists from 7 countries. The first round included open-ended questions and formed the basis for subsequent rounds, in which closed-ended questions were used. Participants continuously received feedback on the results from previous rounds. Consensus was defined as agreement of ≥70% for binary questions and agreement of ≥50% for questions with >2 answer options. The results of the Delphi process were then summarized in a draft manuscript that was circulated among the panel members for feedback.
RESULTS
A total of 5 Delphi rounds were performed. Panel members preferred a single intravenous aspirin bolus or, in jurisdictions in which intravenous aspirin is not available, a glycoprotein IIb/IIIa receptor inhibitor as intraprocedural antiplatelet regimen and a combination therapy of oral aspirin and a P2Y12 inhibitor in the postprocedural period. There was no consensus on the role of platelet function testing in the postprocedural period.
CONCLUSIONS
More and better data on antiplatelet management for carotid stent placement in the setting of endovascular treatment are urgently needed. Panel members preferred intravenous aspirin or, alternatively, a glycoprotein IIb/IIIa receptor inhibitor as an intraprocedural antiplatelet agent, followed by a dual oral regimen of aspirin and a P2Y12 inhibitor in the postprocedural period.
背景与目的
在血管内治疗的情况下，关于颈动脉支架置入术的抗血小板治疗管理，仅有少量数据且缺乏共识。我们旨在为接受血管内治疗和同时紧急颈动脉支架置入的急性缺血性脑卒中患者制定抗血小板治疗的基于共识的算法。
材料与方法
我们进行了文献检索，并采用改良 Delphi 方法，通过网络问卷分多个轮次发送给来自 7 个国家的 19 名神经介入专家组成的国际多学科小组。首轮包括开放式问题，为后续轮次提供了基础，后续轮次采用封闭式问题。参与者持续收到前几轮结果的反馈。共识定义为二进制问题的同意率≥70%，>2 个答案选项的问题的同意率≥50%。Delphi 流程的结果随后总结在一份草稿中，在小组成员中传阅以供反馈。
结果
共进行了 5 轮 Delphi 研究。专家组倾向于单一的静脉内阿司匹林冲击剂量，或者在静脉内阿司匹林不可用的司法管辖区，使用糖蛋白 IIb/IIIa 受体抑制剂作为术中抗血小板治疗方案，以及口服阿司匹林和 P2Y12 抑制剂的联合治疗在术后期间。在术后期间血小板功能检测的作用没有达成共识。
结论
迫切需要更多和更好的数据来指导血管内治疗情况下颈动脉支架置入术的抗血小板治疗管理。专家组倾向于静脉内阿司匹林或替代的糖蛋白 IIb/IIIa 受体抑制剂作为术中抗血小板药物，随后在术后期间采用口服阿司匹林和 P2Y12 抑制剂的双重治疗方案。
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