StandardsAntiplatelets and antithrombotics inneurointerventional procedures:Guideline updateClemens M Schirmer,Ketan R Bulsara,2 Fawaz Al-Mufti3 Neil HaranhalliNeurolnterventLucie Thibault,5 Steven W HettsSNIS Standards and Guidelines CommitteeSurg:Neurosurgery,GeisingerABSTRACTto change antiplatelet or anticoagulant managementHealth System,Wilkes-Barre,Background Antiplatelet and antithromboticinstituted for management of another disease (Class llb,Pennsylvania,USAfirst publDivision of Neurosurgery,medication management before,during,and afterLevel C-LD).(8)Patients with symptomatic intracranialUniversity of Connecticut,neurointerventional procedures has significant practiceatherosclerotic disease (ICAD)should continue DAPTFarmington,Connecticut,USAvariation.This document updates and builds upon thefollowing neurointerventional treatment for secondaryishedNeurology,Neurosurgery,and2014 Society of Neurolnterventional Surgery(SNIS)stroke prevention (Class lla,Level B-NR).(9)FollowingRadiology,Westchester Medicalneurointerventional treatment for ICAD,DAPT shouldCenter,Valhalla,New York,USAGuideline 'Platelet function inhibitor and plateletNeurosurgery and Radiology.function testing in neurointerventional procedures'be continued for at least 3 months.In the absence ofMontefiore Hospital andproviding updates based on the treatment of specificnew stroke or transient ischemic attack symptoms,Medical Center.Bronx.Newpathologies and for patients with specific comorbidities.reversion to SAPT can be considered based on an10.1136is-York,USAScientific Committee,WorldMethods We perfommed a structured literature reviewindividual patient's risk of hemorrhage versus ischemiaFederation of Interventional andof studies that have become available since the 2014(Class llb,Level C-LD).(10)Patients undergoing carotid2022Therapeutic NeuroradiologySNIS Guideline.We graded the quality of the evidence.artery stenting (CAS)should receive DAPT beforeParis,FranceRecommendations were arrived at through a consensusand for at least 3 months following their procedureRadiolgy.Biomedical mging,conference of the authors,then with additional input(Class lla,Level B-R).(11)In patients undergoing CASand Neurological Surgery,UCSF,19844San Francisco California,USAfrom the full SNIS Standards and Guidelines Committeeduring emergent large vessel occlusion ischemic strokeand the SNIS Board of Directorstreatment,it may be reasonable to administer a loadingCorrespondence toResults The management of antiplatelet anddose of intravenous or oral glycoprotein llb/lla or P2Y12Dr Steven W Hetts,Radiology.antithrombotic agents before,during,and afterinhibitor followed by maintenance intravenous infusionUCSF.San Francisco,CA 94143.Mayendovascular neurointerventional procedures continuesor oral dosing to prevent stent thrombosis whether orUSA:steven.hetts@ucsf.eduto evolve.The following recommendations were agreednot the patient has received thrombolytic therapy(Class22023Received 4 November 2022on.(1)
