. 2020 Oct;41(10):1856-1862.

doi: 10.3174/ajnr.A6814. Epub 2020 Sep 17.

Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement

J M Ospel^{1

2}, P Brouwer^{3

4}, F Dorn⁵, A Arthur⁶, M E Jensen⁷, R Nogueira^{8

9}, R Chapot¹⁰, F Albuquerque¹¹, C Majoie¹², M Jayaraman¹³, A Taylor¹⁴, J Liu¹⁵, J Fiehler¹⁶, N Sakai¹⁷, K Orlov¹⁸, D Kallmes¹⁹, J F Fraser²⁰, L Thibault²¹, M Goyal^{22

23}

Affiliations

¹ Department of Clinical Neurosciences (J.M.O., M.G.), University of Calgary, Calgary, Alberta, Canada.
² Department of Radiology (J.M.O.), University Hospital of Basel, Basel, Switzerland.
³ Department of Interventional Neuroradiology (P.B.), Karolinksa Hospital, Stockholm, Sweden.
⁴ University NeuroVascular Center (P.B.), Leiden University Medical Center, Haaglanden Medical Center, Leiden, the Netherlands.
⁵ Institute of Neuroradiology (F.D.), University of Bonn, Bonn, Germany.
⁶ Department of Neurosurgery (A.A.), Semmes-Murphey Clinic/University of Tennessee, Memphis, Tennessee.
⁷ Departments of Neurological Surgery, Radiology, and Medical Imaging (M.E.J.), University of Virginia Health, Charlottesville, Virginia.
⁸ Marcus Stroke & Neuroscience Center (R.N.), Grady Health System, Atlanta, Georgia.
⁹ Department of Neurology (R.N.), Emory University School of Medicine, Atlanta, Georgia.
¹⁰ Department of Neuroradiology (R.C.), Alfred Krupp Krankenhaus Essen, Essen, Germany.
¹¹ Department of Neurosurgery (F.A.), Barrow Neurological Institute, Phoenix, Arizona.
¹² Department of Radiology (C.M.), Academic Medical Center, Amsterdam, the Netherlands.
¹³ Departments of Diagnostic Imaging, Neurology, and Neurosurgery (M.J.), Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.
¹⁴ Groote Schuur Hospital (A.T.), University of Cape Town, Cape Town, South Africa.
¹⁵ Department of Neurosurgery (J.L.), Changhai Hospital Naval Medical University, Shanghai, China.
¹⁶ Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁷ Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan.
¹⁸ Meshalkin National Medical Research Center (K.O.), Novosibirsk, Russian Federation.
¹⁹ Department of Radiology (D.K.), Mayo Clinic, Rochester, Minnesota.
²⁰ Departments of Neurosurgery, Neurology, Radiology, and Neuroscience (J.F.F.), University of Kentucky, Lexington, Kentucky.
²¹ Member of the Scientific Committee of the World Federation of Interventional and Therapeutic Neuroradiology (L.T.).
²² Department of Clinical Neurosciences (J.M.O., M.G.), University of Calgary, Calgary, Alberta, Canada mgoyal@ucalgary.ca.
²³ Department of Diagnostic Imaging (M.G.), University of Calgary, Calgary, Alberta, Canada.

PMID: 32943417
PMCID: PMC7661082
DOI: 10.3174/ajnr.A6814

Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement

J M Ospel et al. AJNR Am J Neuroradiol. 2020 Oct.

. 2020 Oct;41(10):1856-1862.

doi: 10.3174/ajnr.A6814. Epub 2020 Sep 17.

Authors

Affiliations

¹ Department of Clinical Neurosciences (J.M.O., M.G.), University of Calgary, Calgary, Alberta, Canada.
² Department of Radiology (J.M.O.), University Hospital of Basel, Basel, Switzerland.
³ Department of Interventional Neuroradiology (P.B.), Karolinksa Hospital, Stockholm, Sweden.
⁴ University NeuroVascular Center (P.B.), Leiden University Medical Center, Haaglanden Medical Center, Leiden, the Netherlands.
⁵ Institute of Neuroradiology (F.D.), University of Bonn, Bonn, Germany.
⁶ Department of Neurosurgery (A.A.), Semmes-Murphey Clinic/University of Tennessee, Memphis, Tennessee.
⁷ Departments of Neurological Surgery, Radiology, and Medical Imaging (M.E.J.), University of Virginia Health, Charlottesville, Virginia.
⁸ Marcus Stroke & Neuroscience Center (R.N.), Grady Health System, Atlanta, Georgia.
⁹ Department of Neurology (R.N.), Emory University School of Medicine, Atlanta, Georgia.
¹⁰ Department of Neuroradiology (R.C.), Alfred Krupp Krankenhaus Essen, Essen, Germany.
¹¹ Department of Neurosurgery (F.A.), Barrow Neurological Institute, Phoenix, Arizona.
¹² Department of Radiology (C.M.), Academic Medical Center, Amsterdam, the Netherlands.
¹³ Departments of Diagnostic Imaging, Neurology, and Neurosurgery (M.J.), Warren Alpert School of Medicine at Brown University, Providence, Rhode Island.
¹⁴ Groote Schuur Hospital (A.T.), University of Cape Town, Cape Town, South Africa.
¹⁵ Department of Neurosurgery (J.L.), Changhai Hospital Naval Medical University, Shanghai, China.
¹⁶ Department of Diagnostic and Interventional Neuroradiology (J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
¹⁷ Department of Neurosurgery (N.S.), Kobe City Medical Center General Hospital, Kobe, Japan.
¹⁸ Meshalkin National Medical Research Center (K.O.), Novosibirsk, Russian Federation.
¹⁹ Department of Radiology (D.K.), Mayo Clinic, Rochester, Minnesota.
²⁰ Departments of Neurosurgery, Neurology, Radiology, and Neuroscience (J.F.F.), University of Kentucky, Lexington, Kentucky.
²¹ Member of the Scientific Committee of the World Federation of Interventional and Therapeutic Neuroradiology (L.T.).
²² Department of Clinical Neurosciences (J.M.O., M.G.), University of Calgary, Calgary, Alberta, Canada mgoyal@ucalgary.ca.
²³ Department of Diagnostic Imaging (M.G.), University of Calgary, Calgary, Alberta, Canada.

PMID: 32943417
PMCID: PMC7661082
DOI: 10.3174/ajnr.A6814

Erratum in

Erratum.
[No authors listed] [No authors listed] AJNR Am J Neuroradiol. 2021 Oct;42(10):E76. doi: 10.3174/ajnr.A7238. Epub 2021 Aug 5. AJNR Am J Neuroradiol. 2021. PMID: 34353784 Free PMC article. No abstract available.

Abstract

Background and purpose: There is a paucity of data regarding antiplatelet management strategies in the setting of stent-assisted coiling/flow diversion for ruptured intracranial aneurysms. This study aimed to identify current challenges in antiplatelet management during stent-assisted coiling/flow diversion for ruptured intracranial aneurysms and to outline possible antiplatelet management strategies.

Materials and methods: The modified DELPHI approach with an on-line questionnaire was sent in several iterations to an international, multidisciplinary panel of 15 neurointerventionalists. The first round consisted of open-ended questions, followed by closed-ended questions in the subsequent rounds. Responses were analyzed in an anonymous fashion and summarized in the final manuscript draft. The statement received endorsement from the World Federation of Interventional and Therapeutic Neuroradiology, the Japanese Society for Neuroendovascular Therapy, and the Chinese Neurosurgical Society.

Results: Data were collected from December 9, 2019, to March 13, 2020. Panel members achieved consensus that platelet function testing may not be necessary and that antiplatelet management for stent-assisted coiling and flow diversion of ruptured intracranial aneurysms can follow the same principles. Preprocedural placement of a ventricular drain was thought to be beneficial in cases with a high risk of hydrocephalus. A periprocedural dual, intravenous, antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor was preferred as a standard approach. The panel agreed that intravenous medication can be converted to oral aspirin and an oral P2Y12 inhibitor within 24 hours after the procedure.

Conclusions: More and better data on antiplatelet management of patients with ruptured intracranial aneurysms undergoing stent-assisted coiling or flow diversion are urgently needed. Panel members in this DELPHI consensus study preferred a periprocedural dual-antiplatelet regimen with aspirin and a glycoprotein IIb/IIIa inhibitor.

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Figures

**FIG 1.**
Flow chart of the modified DELPHI process as it was used in this study.

**FIG 2.**
Summary of panel consensus for antiplatelet management for stent-assisted coiling/flow diversion of ruptured intracranial aneurysms.

See this image and copyright information in PMC

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References

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Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement

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Antiplatelet Management for Stent-Assisted Coiling and Flow Diversion of Ruptured Intracranial Aneurysms: A DELPHI Consensus Statement

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