好色先生

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Abstract Details

Physician Approaches to Anti-thrombotic Therapies for Acutely Symptomatic Carotid Stenosis: Insights from the Hot Carotid Qualitative Study
Cerebrovascular Disease and Interventional Neurology
P1 - Poster Session 1 (9:00 AM-5:00 PM)
108

To explore the approaches of stroke physicians to peri-procedural anti-thrombotic management of patients with acutely symptomatic carotid stenosis (“hot carotids”)
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, particularly as patients await revascularization. 

We employed a qualitative descriptive methodology to explore the decision-making approaches, opinions, and attitudes of physicians regarding anti-thrombotic regimens for hot carotids. We conducted semi-structured interviews with purposive sampling of 22 stroke physicians (11 neurologists, 3 geriatricians/internists, 5 interventional neuroradiologists, 3 neurovascular surgeons) from 16 centers to discuss perceptions/opinions on hot carotid management.

Important themes revealed from our discussion included limitations of existing clinical trial evidence, competing surgeon versus neurologist/internist preferences for anti-thrombotic regimens, and the challenging choice of single vs dual antiplatelet therapy (DAPT) while awaiting revascularization. We also appreciated regional variations; for example, the use of a single anti-platelet agent was more common among European participants. Whereas most participants were generally comfortable with using multiple anti-thrombotic agents (e.g. DAPT) in patients undergoing carotid artery stenting, for patients undergoing carotid endarterectomy, participants grappled with balancing the potential for greater recurrent stroke risk-reduction against the added peri-operative hemorrhagic risk with multiple agents. Areas of uncertainty also included anti-thrombotic management if already on an antiplatelet agent like acetylsalicylic acid, implications of non-stenotic features of carotid disease (plaque morphology and intraluminal thrombus), the role of newer anti-platelet agents or anticoagulants, platelet aggregation testing, and how soon to start DAPT.

Our qualitative analysis revealed themes that were important to stroke experts. Teams designing international carotid trials may wish to accommodate identified variations in practice patterns and take into consideration areas of uncertainty, such as managing stroke for patients already on anti-thrombotic agents, addressing newer anti-thrombotic agents, and non-stenotic features of carotid disease.

Authors/Disclosures
Aravind Ganesh, MD (Department of Clinical Neurosciences, University of Calgary)
PRESENTER 		Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Figure 1. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Servier Canada. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eisai. Dr. Ganesh has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Eli-Lilly. Dr. Ganesh has received personal compensation in the range of $10,000-$49,999 for serving as an officer or member of the Board of Directors for Let's Get Proof (Collavidence Inc). Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for 好色先生 (journals Neurology and Neurology: Clinical Practice). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association (journal: Stroke). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers (for Frontiers in Neurology). Dr. Ganesh has or had stock in SnapDx.Dr. Ganesh has or had stock in Collavidence Inc.Dr. Ganesh has or had stock in DataSimpl. The institution of Dr. Ganesh has received research support from Canadian Institutes of Health Research . The institution of Dr. Ganesh has received research support from Alberta Innovates. The institution of Dr. Ganesh has received research support from University of Calgary Centre for Clinical Research. The institution of Dr. Ganesh has received research support from Innovation 4 Health. The institution of Dr. Ganesh has received research support from Government of Canada INOVAIT. The institution of Dr. Ganesh has received research support from Campus Alberta Neuroscience. The institution of Dr. Ganesh has received research support from Alzheimer Society of Canada. The institution of Dr. Ganesh has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Ganesh has received research support from New Frontiers in Research Fund. The institution of Dr. Ganesh has received research support from Panmure House. The institution of Dr. Ganesh has received research support from Brain Canada. The institution of Dr. Ganesh has received research support from MSI Foundation. The institution of Dr. Ganesh has received research support from France Canada Research Fund. Dr. Ganesh has received intellectual property interests from a discovery or technology relating to health care.
Benjamin Beland, MD Dr. Beland has nothing to disclose.
Gordon Jewett, MD (South Health Campus) Dr. Jewett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amylyx Pharmaceuticals. Dr. Jewett has received research support from ALS Canada. Dr. Jewett has received research support from Canadian Institute of Health Research.
No disclosure on file
No disclosure on file
Ravinder Jeet Singh, MBBS (Dr. Ravinder Jeet Singh Medicine Professional Corporation) Dr. Singh has nothing to disclose.
Abdulaziz S. Al Sultan, MD Dr. Al Sultan has nothing to disclose.
No disclosure on file
Bijoy Menon, MD (University of Calgary) Dr. Menon has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Menon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Menon has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Circle NVI. Dr. Menon has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke VIN. Dr. Menon has stock in Circle NVI.