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P.062 Physician approaches to anti-thrombotic therapies, imaging and revascularization for acutely symptomatic carotid stenosis: a hot carotid qualitative study

Published online by Cambridge University Press:  24 June 2022

B Beland
Affiliation:
(Calgary)*
A Ganesh
Affiliation:
(Calgary)
G Jewett
Affiliation:
(Calgary)
DJ Campbell
Affiliation:
(Calgary)
M Varma
Affiliation:
(Calgary)
R Singh
Affiliation:
(Sudbury)
A Al-Sultan
Affiliation:
(Calgary)
J Wong
Affiliation:
(Calgary)
B Menon
Affiliation:
(Calgary)
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Abstract

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Background: There are uncertainties regarding the optimal management of acutely symptomatic carotid stenosis (“hot carotids”). We sought to explore the approaches of stroke physicians to anti-thrombotic management, imaging, and revascularization in patients with “hot carotids”. Methods: We used a qualitative descriptive methodology to examine decision-making approaches of physicians regarding the management of hot carotids. We conducted semi-structured interviews with 22 stroke physicians from various specialties in 16 centers across 4 continents. Results: Important themes regarding anti-thrombotic included limitations of existing clinical trial evidence, competing physician preferences, antiplatelet therapy while awaiting revascularization and various regional differences. Timely imaging availability, breadth of information gained, and surgeon/interventionalist preferences were important themes influencing the choice of imaging modality. The choice of revascularization intervention was influenced by healthcare system factors such as use of multidisciplinary review and operating room/angiography suite availability, and patient factors like age and infarct size. Many themes related to uncertainties in the management of hot carotids were also discussed. Conclusions: Our study revealed themes that are important to international stroke experts. We highlight common and divergent practices while underscoring important areas of clinical equipoise and uncertainty. Teams designing international carotid trials may wish to accommodate identified variations in practice patterns and areas of uncertainty.

Type
Poster Presentations
Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of Canadian Neurological Sciences Federation
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P.062 Physician approaches to anti-thrombotic therapies, imaging and revascularization for acutely symptomatic carotid stenosis: a hot carotid qualitative study
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