Paraskevas KI, Gloviczki P, Mikhailidis DP, Antignani PL, Dardik A, Eckstein HH, Faggioli G, Fernandes JFE, Fraedrich G, Gupta A, Jawien A, Jezovnik MK, Kakkos SK, Knoflach M, Lal BK, Lanza G, Liapis CD, Loftus IM, Mansilha A, Millon A, Pini R, Poredos P, Proczka R, Ricco JB, Rundek T, Saba L, Schlachetzki F, Silvestrini M, Spinelli F, Stilo F, Suri JS, Zeebregts CJ, Lavie CJ, Chaturvedi S
Background: The optimal antithrombotic (antiplatelet or anticoagulant) treatment of patients undergoing extracranial carotid artery interventions is a subject of debate. The aim of this multidisciplinary document was to critically reviewthe recommendations of current guidelines, taking into consideration the results of recently published studies.Methods: The various antithrombotic strategies reported were evaluated for asymptomatic and symptomatic patients undergoing extracranial carotid artery interventions (endarterectomy, transfemoral carotid artery stenting [CAS] or transcarotid artery revascularization [TCAR]). Based on a critical review, a series of recommendations were formulated by an international expert panel.Results: For asymptomatic patients, we recommend low-dose aspirin (75-100 mg/day) or clopidogrel (75 mg/day) with the primary goal to reduce the risk of myocardial infarction and cardiovascular event rates rather than to reduce the risk of stroke. For symptomatic patients, we recommend dual antiplatelet treatment (DAPT) initiatedwithin 24 h of the index event to reduce the risk of recurrent events. We suggest that following transfemoral CAS or TCAR, patients continue DAPT for 1 month after which a single antiplatelet agent is used. High level of evidence to support anticoagulant treatment for patients with carotid artery disease is lacking.Conclusions: The antithrombotic treatment offered to carotid patients should be individualized, taking into account the presence of symptoms, the type of intervention and the goal of the treatment. The duration and type of DAPT (ticagrelor instead of clopidogrel) should be evaluated in future trials. (c) 2022 Elsevier Inc. All rights reserved.