了解医生对大血管闭塞患者联合溶栓和血栓切除术的偏好：国际横断面调查。

IF 2 4区医学 Q3 NEUROSCIENCES

Journal of Stroke & Cerebrovascular Diseases Pub Date : 2024-09-19 DOI:10.1016/j.jstrokecerebrovasdis.2024.108022

A.Z. Siddiqi , N. Kashani , Adam A. Dmytriw , D. Yavagal , G. Saposnik , M. Tymianski , C. Adams , M.D. Hill , Dar Dowlatshahi , Aristeidis H Katsanos , B.K. Menon , A. Ganesh , N. Singh

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引用次数: 0

摘要

背景：最近发表的一项个人参与者水平的荟萃分析发现，单纯 EVT 并非优于联合静脉溶栓（IVT）和 EVT。我们的目的是确定影响医生选择 IVT 单独治疗还是 EVT 单独治疗还是联合治疗的因素：我们对治疗 AIS 患者的医生进行了一项国际性、结构化、仅限受邀者参与的调查。我们向受访者提出了 16 道多项选择题。其中 14 个问题涉及向受访者提供一个临床情景。在每个场景中，患者都表现为 AIS 并伴有 LVO，临床或影像学特征各不相同：共有 282 名卒中医生（平均年龄 46 岁，75% 为男性）参与了调查。对于同时符合 IVT 和 EVT 条件的 LVO 中风患者，在没有其他限定条件的情况下，220 名受访者（85.9%）选择了联合治疗。对于年龄超过 80 岁的患者，191 人（74%）选择了联合疗法，如果患者患有痴呆症，则选择联合疗法的人数减少到 121 人（48.2%），如果患者正在接受双联抗血小板疗法（DAPT），则选择联合疗法的人数减少到 148 人（57.4%）。在为 80 岁以上患者选择联合疗法的受访者中，只有 105 人（56.8%）会为痴呆症患者选择同样的疗法。就影像学因素而言，177 位受访者（72.8%）选择对颅内颈动脉闭塞采取联合疗法，而对串联闭塞则减少到 160 位（65.3%）。总体而言，88 名受访者（38%）同意 "我对患者护理中的不确定性感到不安 "这一说法：结论：对于典型的低密度脂蛋白血栓形成导致的 AIS 患者，大多数受访者仍选择联合血管再通方法，但在复杂情况下，决策差异会增加。

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Understanding physician preferences about combined thrombolysis and thrombectomy in patients with large vessel occlusion: An international cross-sectional survey

Background

A recently published individual participant-level meta-analysis found that EVT alone was not non-inferior to combined intravenous thrombolysis (IVT) and EVT. Our aim was to determine factors that influence physicians’ treatment choice of IVT-alone versus EVT-alone versus a combined approach.

Methods

We performed an international, structured, invite-only survey among physicians treating patients presenting with AIS. Respondents were asked 16 multiple choice questions. Fourteen questions involved the respondent being provided with a clinical scenario. In each scenario, a patient was presenting with an AIS with LVO, varying a single clinical or imaging feature.

Results

A total of 282 stroke physicians (mean age 46 years, 75 % males) participated in the survey. In LVO stroke, eligible for both IVT and EVT, without other qualifiers, 220 (85.9 %) respondents chose to pursue a combined approach. For age over 80 years, 191 (74 %) participants opted for combined approach, which decreased to 121 (48.2 %) with dementia and 148 (57.4 %) if the patient was on dual anti-platelet therapy (DAPT). Of respondents choosing combination therapy in a patient above the age of 80, only 105 (56.8 %) would pursue the same in a patient with dementia. For imaging factors, 177 (72.8 %) opted for a combined approach for intracranial carotid occlusion, which decreased to 160 (65.3 %) in tandem occlusions. Overall, 88 (38 %) respondents agreed to the statement “I am uncomfortable with uncertainty in patient care”.

Conclusions

In a typical patient with AIS due to LVO, most respondents still choose a combined revascularization approach but discrepancy in decision-making increases in complex scenarios.

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来源期刊

Journal of Stroke & Cerebrovascular Diseases Medicine-Surgery

CiteScore

5.00

自引率

4.00%

发文量

583

审稿时长

62 days

期刊介绍： The Journal of Stroke & Cerebrovascular Diseases publishes original papers on basic and clinical science related to the fields of stroke and cerebrovascular diseases. The Journal also features review articles, controversies, methods and technical notes, selected case reports and other original articles of special nature. Its editorial mission is to focus on prevention and repair of cerebrovascular disease. Clinical papers emphasize medical and surgical aspects of stroke, clinical trials and design, epidemiology, stroke care delivery systems and outcomes, imaging sciences and rehabilitation of stroke. The Journal will be of special interest to specialists involved in caring for patients with cerebrovascular disease, including neurologists, neurosurgeons and cardiologists.