Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists.
Management of Patients With Patent Foramen Ovale and Stroke: A National Survey of Interventional Cardiologists and Vascular Neurologists.
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DOI：
10.1161/jaha.123.029451
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发表时间：
2023-07-04
影响因子：
5.4
通讯作者：
Favilla, Christopher G. G.
中科院分区：
文献类型：
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作者：
Khan, Farhan;Derbas, Laith A. A.;Messe, Steven R. R.;Kavinsky, Clifford;Kasner, Scott E. E.;Favilla, Christopher G. G.
多项临床试验的结果支持在选定患者中进行隐源性卒中后卵圆孔未闭闭合，但尚不清楚新数据和更新的专业学会指南如何影响临床实践。在这里，我们的目的是比较卒中神经科医生和介入心脏病学家如何处理患有卵圆孔未闭的隐源性卒中患者，以及关键的解剖和临床因素如何影响决策。对美国1556名血管神经学家和1057名介入心脏病学家进行了电子调查。调查涉及患者年龄、术前检查和术后抗血栓药物等因素。临床小插曲突出了关键变量，并使用5分制Likert量表评估提供者对关闭的支持水平。共有491份调查回复，来自301名（1556名）血管神经学家和190名（1057名）介入心脏病学家，总回复率为19%。血管神经科医生更倾向于基于年龄较大而建议不进行闭合（P<0.001）。介入心脏病专家在一系列临床事件中更支持闭合，包括非常仔细选择的隐源性卒中患者（P<0.001），具有高风险替代卒中原因的患者（P<0.001），以及一系列突出临床变量的病例缺乏数据。大多数介入医生（88%）在寻求卵圆孔未闭闭合前寻求神经科咨询。介入心脏病专家比血管神经病专家更可能支持在一系列情况下进行卵圆孔未闭闭合。这强调了合作和共同决策的重要性，但也揭示了专业社会教育推广的机会。
Results from multiple clinical trials support patent foramen ovale closure after cryptogenic stroke in select patients, but it remains unclear how new data and updated professional society guidelines have impacted clinical practice. Here, we aimed to compare how stroke neurologists and interventional cardiologists approach patients with cryptogenic stroke with patent foramen ovale and how critical anatomic and clinical factors influence decision making. An electronic survey was administered to 1556 vascular neurologists and 1057 interventional cardiologists throughout the United States. The survey addressed factors such as patient age, preclosure workup, and postclosure antithrombotics. Clinical vignettes highlighted critical variables and used a 5‐point Likert scale to assess the providers' level of support for closure. There were 491 survey responses received from 301 (of 1556) vascular neurologists and 190 (of 1057) interventional cardiologists, with an overall response rate of 19%. Vascular neurologists were more likely to recommend against closure on the basis of older age (P<0.001). Interventional cardiologists are more supportive of closure across a range of clinical vignettes, including a very carefully selected patient with cryptogenic stroke (P<0.001), a patient with a high‐risk alternative stroke cause (P<0.001), and a range of cases highlighting clinical variables where data are lacking. The majority of interventionalists (88%) seek neurology consultation before pursuing patent foramen ovale closure. lnterventional cardiologists are more likely than vascular neurologists to support patent foramen ovale closure across a range of situations. This emphasizes the importance of collaboration and shared decision making, but also reveals an opportunity for professional society educational outreach.