Background: Whereas the beneficial effect of
antiplatelet therapy for recurrent stroke prevention is well-established,
uncertainties remain regarding the optimal anti-thrombotic regimen for
acutely symptomatic carotid stenosis (“hot carotid”), particularly as
patients await revascularization. We sought to explore the approaches of
stroke physicians to peri-procedural anti-thrombotic management of patients
with “hot carotids”. Methods: We conducted
semi-structured interviews regarding “hot carotid” management with purposive
sampling of 20 stroke physicians from 14 centres in North America, Europe,
Asia, and Australia. We identified key themes using conventional qualitative
content analysis. Results: Important themes revealed
from our discussion included limitations of existing clinical trial
evidence, competing surgeon versus neurologist/internist preferences, and
single vs dual antiplatelet therapy (DAPT) while awaiting revascularization.
Areas of uncertainty included the management of stroke while on aspirin,
implications of non-stenotic features of carotid disease (intraluminal
thrombus, plaque morphology), the role of newer anti-platelet agents or
anticoagulants, platelet aggregation testing, and how soon to start DAPT.
Conclusions: Our qualitative analysis revealed
themes that were important to stakeholders in stroke care. Teams designing
international trials will have to accommodate identified variations in
anti-thrombotic practice patterns and take into consideration areas of
uncertainty, such as newer anti-thrombotic agents, and the implication of
non-stenotic features of carotid disease.
Do Integrated Sysyems of Stroke Care Improve Symptom to Surgery Times in Patients with Symptomatic Carotid Stenosis? A Decision Tree Analysis
