Periprocedural DAPT for transfemoral carotid artery stenting*

DAPT: dual antiplatelet therapy; ASA: aspirin; TF-CAS: transfemoral carotid artery stenting.
* We use a regimen based on the Carotid Revascularization Endarterectomy versus Stent (CREST) Trial. We also provide statin therapy. For those not already on statins, we initiate atorvastatin 40 mg orally once daily for seven days before the procedure or we give a loading dose of 80 mg orally once 12 hours before the procedure.
¶ The timing of the DAPT loading and subsequent dosing depends on procedure scheduling. Typically, we provide loading doses once the procedure is scheduled and provide daily dosing starting 12 hours after the loading doses up until the time of the procedure. For urgent cases, loading doses are provided no less than four hours before the procedure.
Δ For TF-CAS, although we favor higher doses, guidelines support a range of 75 to 325 mg ASA.
◊ For patients with a history of neck irradiation, we continue DAPT indefinitely.