scholarly journals P.065 Physician Approaches to Anti-thrombotic Therapies for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study

2021 ◽  
Vol 48 (s3) ◽  
pp. S37-S37
Author(s):  
B Beland ◽  
A Ganesh ◽  
G Jewett ◽  
DJ Campbell ◽  
M Varma ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Antiplatelet Therapy ◽  
Qualitative Content Analysis ◽  
Recurrent Stroke ◽  
Stroke Care ◽  
Plaque Morphology ◽  
Structured Interviews ◽  
Carotid Disease ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

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.

scholarly journals P.064 Physician Approaches to Imaging and Revascularization for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study

2021 ◽  
Vol 48 (s3) ◽  
pp. S37-S37
Author(s):  
A Ganesh ◽  
B Beland ◽  
G Jewett ◽  
DJ Campbell ◽  
M Varma ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Qualitative Content Analysis ◽  
Imaging Modality ◽  
Plaque Morphology ◽  
Structured Interviews ◽  
Intraluminal Thrombus ◽  
Symptomatic Carotid ◽  
Angiography Suite ◽  
Symptomatic Carotid Stenosis

Background: Evidence informing the choice between endarterectomy and stenting for acutely symptomatic carotid stenosis (“hot carotid”) is dated, and uncertainties remain regarding the optimal imaging modality. We sought to explore the thoughts of stroke physicians regarding the perioperative management of patients with acute symptomatic carotid stenosis. 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: Timely imaging availability, breadth of information gained, and surgeon/interventionalist preference emerged as important themes informing the choice of imaging modality. Multidisciplinary decision making, operating room/angiography suite availability, and implications of patient age and infarct size were important themes related to the choice of revascularization. Areas of uncertainty included utility of carotid plaque imaging, timing of revascularization, and the role of intervention with borderline stenosis or intraluminal thrombus. Conclusions: Our qualitative analysis revealed themes that were important to stroke experts. Teams designing international trials will have to accommodate identified variations in practice patterns and take into consideration areas of uncertainty, such as timing of revascularization, imaging of carotid plaque and non-stenotic features of carotid disease (intraluminal thrombus, plaque morphology).

Abstract TP135: Urgent Treatment for Symptomatic Carotid Stenosis: The Pittsburgh Revascularization and Treatment Emergently After Stroke Protocol

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Daniel Tonetti ◽  
Brian Jankowitz ◽  
Kenmuir Cynthia ◽  
Benjamin Zussman ◽  
Rahul Rao ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Primary Outcome ◽  
Recurrent Stroke ◽  
Carotid Stenting ◽  
Clinical Equipoise ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Recorded Data ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Background: Patients with symptomatic carotid stenosis remain at high risk of early recurrent stroke without revascularization. The aim of this report is to analyze prospectively-recorded data from an institutional protocol that standardized the urgent (<48 hours) treatment of patients presenting with symptomatic carotid stenosis and underwent either carotid stenting (CAS) or carotid endarterectomy (CEA). Methods: All patients presenting over 28 months to a comprehensive stroke center with symptomatic carotid stenosis within 48 hours of index event were screened for inclusion. All patients were given dual antiplatelet therapy. If there was clinical equipoise between CEA and CAS, patients underwent angiography and subsequently revascularization if DSA demonstrated ≥50% stenosis. The primary outcome was a composite of stroke or death within 30 days. Results: 178 patients with a diagnosis of recently symptomatic carotid stenosis were included; 120 patients (67%) met criteria. 59 patients underwent CEA and 61 patients underwent CAS. There were not significant differences in the primary outcome; 3 patients (5.1%) in the CEA arm and 3 patients (4.9%) in the CAS arm met the primary outcome. Conclusion: In this prospective analysis, urgent revascularization for symptomatic carotid stenosis can be done with equivalently low rates of stroke or death, regardless of revascularization strategy.

Obstructed Flow

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Transient Ischemic Attack ◽  
Recurrent Stroke ◽  
Early Period ◽  
Carotid Stenting ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
Ischemic Attack

Patients with symptomatic carotid stenosis benefit from revascularization. The risk of recurrent stroke is highest during the early period after a transient ischemic attack or stroke. Carotid endarterectomy and carotid stenting are options for treatment and should be considered within the first 2 weeks if feasible.

scholarly journals Risk of Early Recurrent Stroke in Symptomatic Carotid Stenosis

2015 ◽  
Vol 61 (2) ◽  
pp. 570
Author(s):  
S. Strömberg ◽  
A. Nordanstig ◽  
T. Bentzel ◽  
K. Österberg ◽  
G.M.L. Bergström
Keyword(s):  
Carotid Stenosis ◽  
Recurrent Stroke ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis

scholarly journals Simultaneous assessment of plaque morphology, cerebral micro-embolic signal status and platelet biomarkers in patients with recently symptomatic and asymptomatic carotid stenosis

2019 ◽  
Vol 40 (11) ◽  
pp. 2201-2214
Author(s):  
Stephen J Murphy ◽  
Soon T Lim ◽  
Justin A Kinsella ◽  
Sean Tierney ◽  
Bridget Egan ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Transcranial Doppler Ultrasound ◽  
Plaque Morphology ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Symptomatic Carotid ◽  
Reticulated Platelets ◽  
Asymptomatic Patients ◽  
Symptomatic Carotid Stenosis ◽  
Simultaneous Assessment

The relationship between plaque morphology, cerebral micro-embolic signals (MES) and platelet biomarkers in carotid stenosis patients warrants investigation. We combined data from two prospective, observational studies to assess carotid plaque morphology and relationship with cerebral MES and platelet biomarkers in patients with recently symptomatic (≤4 weeks of transient ischaemic attack (TIA)/ischaemic stroke) versus asymptomatic carotid stenosis. Plaque morphology on ultrasound was graded with Grey-Scale Median (GSM) and Gray–Weale (GW) scoring. Bilateral transcranial Doppler ultrasound classified patients as ‘MES+ve’ or ‘MES-ve’. Full blood counts were analysed and flow cytometry quantified CD62P and CD63 expression, leucocyte-platelet complexes and reticulated platelets. Data from 42 recently symptomatic carotid stenosis patients were compared with those from 36 asymptomatic patients. There were no differences in median GSM scores between symptomatic and asymptomatic patients (25 vs. 30; P = 0.31) or between MES+ve vs. MES-ve symptomatic patients (36 vs. 25; P = 0.09). Symptomatic patients with GSM-echodense plaques (GSM ≥25) had higher platelet counts (228 vs. 191 × 109/L), neutrophil–platelet (3.3 vs. 2.7%), monocyte–platelet (6.3 vs. 4.55%) and lymphocyte–platelet complexes (2.91 vs. 2.53%) than ‘ asymptomatic patients with GSM-echodense plaques’ ( P ≤ 0.03). Recently, symptomatic carotid stenosis patients with ‘GSM-echodense plaques’ have enhanced platelet production/secretion/activation compared with their asymptomatic counterparts. Simultaneous assessment with neurovascular imaging and platelet biomarkers may aid risk-stratification in carotid stenosis.

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