{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,27]],"date-time":"2026-05-27T20:46:08Z","timestamp":1779914768281,"version":"3.53.1"},"reference-count":22,"publisher":"Cambridge University Press (CUP)","issue":"2","license":[{"start":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T00:00:00Z","timestamp":1676937600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Can. J. Neurol. Sci."],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>ABSTRACT:<\/jats:title><jats:sec id=\"S0317167123000288_as1\"><jats:title>Background:<\/jats:title><jats:p>Whereas the beneficial effect of antiplatelet therapy for recurrent stroke prevention has been well established, uncertainties remain regarding the optimal antithrombotic regimen for recently symptomatic carotid stenosis. We sought to explore the approaches of stroke physicians to antithrombotic management of patients with symptomatic carotid stenosis.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167123000288_as2\"><jats:title>Methods:<\/jats:title><jats:p>We employed a qualitative descriptive methodology to explore the decision-making approaches and opinions of physicians regarding antithrombotic regimens for symptomatic carotid stenosis. We conducted semi-structured interviews with a purposive sample of 22 stroke physicians (11 neurologists, 3 geriatricians, 5 interventional-neuroradiologists, and 3 neurosurgeons) from 16 centers on four continents to discuss symptomatic carotid stenosis management. We then conducted thematic analysis on the transcripts.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167123000288_as3\"><jats:title>Results:<\/jats:title><jats:p>Important themes revealed from our analysis included limitations of existing clinical trial evidence, competing surgeon versus neurologist\/internist preferences, and the choice of antiplatelet therapy while awaiting revascularization. There was a greater concern for adverse events while using multiple antiplatelet agents (e.g., dual-antiplatelet therapy (DAPT)) in patients undergoing carotid endarterectomy compared to carotid artery stenting. Regional variations included more frequent use of single antiplatelet agents among European participants. Areas of uncertainty included antithrombotic management if already on an antiplatelet agent, implications of nonstenotic features of carotid disease, the role of newer antiplatelet agents or anticoagulants, platelet aggregation testing, and timing of DAPT.<\/jats:p><\/jats:sec><jats:sec id=\"S0317167123000288_as4\"><jats:title>Conclusion:<\/jats:title><jats:p>Our qualitative findings can help physicians critically examine the rationale underlying their own antithrombotic approaches to symptomatic carotid stenosis. Future clinical trials may wish to accommodate identified variations in practice patterns and areas of uncertainty to better inform clinical practice.<\/jats:p><\/jats:sec>","DOI":"10.1017\/cjn.2023.28","type":"journal-article","created":{"date-parts":[[2023,2,21]],"date-time":"2023-02-21T05:46:56Z","timestamp":1676958416000},"page":"210-219","source":"Crossref","is-referenced-by-count":4,"title":["Physician Approaches to Antithrombotic Therapies for Recently Symptomatic Carotid Stenosis"],"prefix":"10.1017","volume":"51","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5520-2070","authenticated-orcid":false,"given":"Aravind","family":"Ganesh","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Beland","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8268-5677","authenticated-orcid":false,"given":"Gordon A.E.","family":"Jewett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.T.","family":"Campbell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malavika","family":"Varma","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1201-8067","authenticated-orcid":false,"given":"Ravinder-Jeet","family":"Singh","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abdulaziz","family":"Al-Sultan","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4777-9456","authenticated-orcid":false,"given":"John H.","family":"Wong","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bijoy K.","family":"Menon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2023,2,21]]},"reference":[{"key":"S0317167123000288_ref18","article-title":"European society for vascular surgery (ESVS) 2023 clinical practice guidelines on the management of atherosclerotic carotid and vertebral artery disease","author":"Naylor","year":"2022;65:7\u201311","journal-title":"Eur J Vasc Endovasc Surg"},{"key":"S0317167123000288_ref21","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1212\/CPJ.0000000000000812","article-title":"Equipoise in management of patients with acute symptomatic carotid stenosis (hot carotid)","volume":"11","author":"Ganesh","year":"2021","journal-title":"Neurol Clin Pract."},{"key":"S0317167123000288_ref22","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)31133-4"},{"key":"S0317167123000288_ref4","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.1030460"},{"key":"S0317167123000288_ref9","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(07)70274-0"},{"key":"S0317167123000288_ref2","doi-asserted-by":"publisher","DOI":"10.1159\/000341410"},{"key":"S0317167123000288_ref10","doi-asserted-by":"crossref","unstructured":"10. Emmel, N. Sampling and choosing cases in qualitative research: a realist approach. London, 2013. Available at\u00a0 https:\/\/methods.sagepub.com\/book\/sampling-and-choosing-cases-in-qualitative-research; accessed September 26, 2022.","DOI":"10.4135\/9781473913882"},{"key":"S0317167123000288_ref8","doi-asserted-by":"publisher","DOI":"10.1002\/1098-240X(200008)23:4<334::AID-NUR9>3.0.CO;2-G"},{"key":"S0317167123000288_ref7","first-page":"e000127","article-title":"Physician approaches to imaging and revascularization for acutely symptomatic carotid stenosis: insights from the hot carotid qualitative study","volume":"2","author":"Ganesh","year":"2022","journal-title":"Stroke: Vasc Interv Neurol"},{"key":"S0317167123000288_ref11","unstructured":"11. Gobo, G , Qualitative Research Practice, 2004, London: SAGE Publications Ltd. https:\/\/methods.sagepub.com\/book\/qualitative-research-practice; accessed September 26, 2022."},{"key":"S0317167123000288_ref13","doi-asserted-by":"publisher","DOI":"10.1080\/14780887.2013.801543"},{"key":"S0317167123000288_ref5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1215340"},{"key":"S0317167123000288_ref17","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa2111749"},{"key":"S0317167123000288_ref19","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejvs.2017.06.021"},{"key":"S0317167123000288_ref1","doi-asserted-by":"publisher","DOI":"10.1161\/01.STR.30.12.2513"},{"key":"S0317167123000288_ref20","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.116.024913"},{"key":"S0317167123000288_ref6","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1800410"},{"key":"S0317167123000288_ref12","doi-asserted-by":"publisher","DOI":"10.1177\/1744987120927206"},{"key":"S0317167123000288_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/intqhc\/mzm042"},{"key":"S0317167123000288_ref3","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1412981"},{"key":"S0317167123000288_ref15","doi-asserted-by":"publisher","DOI":"10.1177\/2050312118822927"},{"key":"S0317167123000288_ref16","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2020-038469"}],"container-title":["Canadian Journal of Neurological Sciences \/ Journal Canadien des Sciences Neurologiques"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S0317167123000288","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,4,3]],"date-time":"2024-04-03T04:38:56Z","timestamp":1712119136000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S0317167123000288\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,2,21]]},"references-count":22,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["S0317167123000288"],"URL":"https:\/\/doi.org\/10.1017\/cjn.2023.28","relation":{},"ISSN":["0317-1671","2057-0155"],"issn-type":[{"value":"0317-1671","type":"print"},{"value":"2057-0155","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,2,21]]}}}