Abstract Details

Title Physician Approaches to the Initial Management of an Intraluminal Thrombus in Recently Symptomatic Carotid Artery Stenosis: Results from the Hot Carotid Study

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) S20 - Cerebrovascular Disease and Interventional Neurology: Clinical Trials and Outcomes Studies (4:18 PM-4:30 PM)

Poster/Presentation
Number 005

Background

Intraluminal thrombi (ILT) are thought to be at high short-term risk of recurrent ischemic events without revascularization and high risk of peri-operative stroke when early revascularization is attempted. Due to the lack of high-quality evidence, ILT management approaches rely on individual or institutional preferences, but the current state of practice is unclear.

Objective

To use mixed methods to explore the practices of international experts when managing patients with an intraluminal carotid artery thrombus in the context of recently symptomatic carotid artery stenosis.

Design/Methods

This mixed methods study analyzed themes from semi-structured interviews with 22 stroke physicians from 16 centers in 6 world regions, paired with a worldwide case-based survey of 628 stroke physicians conducted through the “Practice Current” section of Neurology: Clinical Practice.

Results

In the thematic analysis of the interviews and quantitative analysis of the survey, participants generally favoured using anticoagulation with or without one or more antiplatelet agents at least short-term in patients with ILT (463/628, 74%). Despite a preference for anticoagulation, a theme of uncertainty regarding optimal antithrombotic management was present in the thematic analysis. Multivariable regression analysis of the survey data also showed significant regional variability regarding antithrombotic choices in treating ILT, with the USA and Canada favouring anticoagulation compared to other surveyed regions. Additional themes identified included a preference for re-imaging patients in 3-5 days after initiating treatment to look for complete or partial clot resolution, at which point most experts would then be comfortable proceeding with revascularization if indicated, though significant uncertainty regarding the optimal timing of revascularization was noted in the analysis.

Conclusions

These results highlight current practice patterns in patients with ILT and show that while there appears to some preference for using anticoagulant agents and reimaging patients in 3-5 days, there is still considerable equipoise regarding the most appropriate management of patients with ILT.

Authors/Disclosures
Davis Maclean, MD PRESENTER	Dr. Maclean has nothing to disclose.
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.
Luca Bartolini, MD, FAAN (Meyer Children's Hospital)	Dr. Bartolini has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology.
	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.
Aravind Ganesh, MD (Department of Clinical Neurosciences, University of Calgary)	Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MD Analytics. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MyMedicalPanel. 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 $0-$499 for serving as a Consultant for DeepBench. An immediate family member of Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CTC Communications Corp. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Atheneum. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Research on Mind. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Creative Research Designs. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. 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 $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 American Academy of Neurology (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 received personal compensation in the range of $10,000-$49,999 for serving as an Expert Witness for Grosso Harper Law. Dr. Ganesh has stock in SnapDx. Dr. Ganesh has stock in TheRounds.com. Dr. Ganesh has stock in Advanced Health Analytics (AHA Health Ltd). Dr. Ganesh has stock in Collavidence Inc. Dr. Ganesh has 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 Canadian Cardiovascular Society. 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.