title: Heterogeneous practice patterns regarding antiplatelet medications for neuroendovascular stenting in the USA: a multicenter survey.
abstract: BACKGROUND
  Adequate dual antiplatelet (AP) therapy is imperative when performing neurovascular stenting procedures. Currently, no consensus for the ideal AP regimen exists. Thus the present study aimed to gain a better understanding of real world practice AP patterns by surveying neurointerventional surgeons.
  
  
  METHODS
  Survey links were emailed to 296 neurointerventional surgeons practicing in the USA, asking 51 questions including demographics, stent specific use, AP pre and post-medication, types of APs, point of care (POC) assessment, complications, and outcomes. Data were collected and analyzed using Research Electronic Data Capture (REDCap).
  
  
  RESULTS
  74 participants responded; 56.8% were from academic centers. Participants treated an average of 5.5 aneurysms per month. They placed an average of 1.6 intracranial stents and 1.4 cervical stents per month. Mean number of pipeline embolization devices (PEDs) placed per year was 15.2. Heterogeneity existed regarding AP regimens; the most frequent included acetylsalicylic acid (ASA) 325 mg+Plavix 75 mg daily (for 7 days prior) and ASA 325 mg+Plavix 75 mg daily (for 5 days prior) for routine placement of intracranial and cervical stents, respectively. For emergency placement, ASA 325 mg+Plavix 600 mg (at time of surgery) was the most frequently used. 46.8% routinely used POC testing, most frequently VerifyNow (Accumetrics, San Diego, California, USA); the most common threshold determining a non-responder was <30% inhibition. 85.7% used POC for PED placement. Management changes based on POC testing were diverse.
  
  
  CONCLUSIONS
  The results highlight the heterogeneity of current practices regarding AP medication regimens during neurovascular stenting. Given its importance, evidence based protocols are imperative. Minimal literature exists focusing on neurovasculature, and therefore understanding current practice patterns represents a first step toward generating these protocols.
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Ryan W F
authors.initials: RW
authors.lastname: Faught
authors.affiliation: Department of Neurointerventional Surgery, Christiana Care Health System, Wilmington, Delaware, USA.
authors.forename: Sudhakar R
authors.initials: SR
authors.lastname: Satti
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Robert W
authors.initials: RW
authors.lastname: Hurst
authors.affiliation: Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Pukenas
authors.affiliation: Department of Neurosurgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Michelle Janine
authors.initials: MJ
authors.lastname: Smith
mesh_terms: D001807:Blood Vessel Prosthesis / Q000706:statistics & numerical data; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000706:statistics & numerical data; D002561:Cerebrovascular Disorders / Q000188:drug therapy / Q000601:surgery*; D003625:Data Collection; D006801:Humans; D020767:Intracranial Thrombosis / Q000517:prevention & control; D009493:Neurosurgery / Q000706:statistics & numerical data*; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015607:Stents / Q000706:statistics & numerical data*; D014481:United States
chemical_list: D010975:Platelet Aggregation Inhibitors
keywords: Drug; Flow Diverter; Platelets; Standards; Stent