Perioprocedural DAPT for transcarotid artery revascularization*

TCAR: transcarotid artery revascularization; DAPT: dual antiplatelet therapy; ASA: aspirin.
* We use a regimen based on the Safety and Efficacy Study for Reverse Flow Used During Carotid Artery Stenting Procedure (ROADSTER) trial, which was derived from the Carotid Revascularization Endarterectomy versus Stent Trial (CREST), modified slightly. 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 DAPT loading and subsequent dosing depends on procedure scheduling. Typically, we provide loading doses once the procedure is scheduled and provide daily dosing starting 24 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 patients with a history of neck irradiation, we continue DAPT indefinitely.