Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists.
Intracranial stenosis: impact of randomized trials on treatment preferences of US neurologists and neurointerventionists.
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DOI：
10.1159/000358120
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发表时间：
2014
期刊：
影响因子：
--
通讯作者：
Chimowitz MI
中科院分区：
文献类型：
--
作者：
Turan TN;Cotsonis G;Lynn MJ;Wooley RH;Swanson S;Williams JE;Stern BJ;Derdeyn CP;Fiorella D;Chimowitz MI
在过去的几十年里，症状性颅内狭窄患者预防卒中的药物和血管内治疗选择已经发展，但尚未研究2项主要的多中心随机卒中预防试验对医生实践的影响。我们试图确定美国医生对颅内动脉粥样硬化性狭窄（ICAS）患者治疗选择的变化，这是在2项NIH资助的临床试验中进行的，这些试验研究了药物治疗（抗血栓药物和风险因素控制）和经皮腔内血管成形术和支架植入术（PTAS）。ICAS患者治疗实践的匿名调查在3个时间点发送给医生：在NIH资助的华法林-阿司匹林症状性颅内疾病（WASID）试验发表之前（2004年，WASID之前）; WASID出版后1年（后WASID，2006年）;以及NIH资助的《支架植入和积极的医疗管理预防颅内狭窄患者复发性卒中》发表后1年（SAMMPRIS）试验（SAMMPRIS后，2012年）。邀请神经科医生参加WASID前调查（n = 525）。邀请神经科医师和神经介入医师参加WASID后（n = 598）和SAMMPRIS后（n = 2080）调查。这3项调查是使用基于网络的调查工具进行的，这些工具通过电子邮件发送，并通过电子邮件和传统邮件发送基于传真的回复表格。使用卡方检验分析数据。在WASID前，华法林和阿司匹林在ICAS患者中预防卒中的作用是均衡的。在前循环（WASID前= 44%，WASID后= 85%，SAMMPRIS后= 94%）和后循环（WASID前= 36%，WASID后= 74%，SAMMPRIS后= 83%）的所有3项调查中，建议对ICAS进行抗血小板治疗的受访者数量均有所增加。WASID后最常推荐的抗血小板药物是阿司匹林，但SAMMPRIS后是阿司匹林和氯吡格雷的联合用药。在> 25%的ICAS患者中推荐PTAS的神经科医生比例从WASID前（8%）到WASID后（12%）略有增加，但在SAMMPRIS后再次下降（6%）。在> 25%的ICAS患者中推荐PTAS的神经介入医生比例从WASID后（49%）降至SAMMPRIS后（17%）。接受调查的美国医生对ICAS的推荐治疗在3个调查期内不同，反映了2项NIH资助的ICAS临床试验的结果，并表明这些临床试验改变了美国的实践。
Medical and endovascular treatment options for stroke prevention in patients with symptomatic intracranial stenosis have evolved over the past several decades, but the impact of 2 major multi-center randomized stroke prevention trials on physician practices has not been studied. We sought to determine changes in US physician treatment choices for patients with intracranial atherosclerotic stenosis (ICAS) following 2 NIH-funded clinical trials that studied medical therapies (antithrombotic agents and risk factor control) and percutaneous transluminal angioplasty and stenting (PTAS). Anonymous surveys on treatment practices in patients with ICAS were sent to physicians at 3 time points: before publication of the NIH-funded Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) Trial (pre-WASID, 2004); 1 year after WASID publication (post-WASID, 2006); and 1 year after the publication of the NIH-funded Stenting and Aggressive Medical Management for Preventing Recurrent stroke in Intracranial Stenosis (SAMMPRIS) Trial (post-SAMMPRIS, 2012). Neurologists were invited to participate in the pre-WASID survey (n=525). Neurologist and Neurointerventionists were invited to participate in the post-WASID (n=598) and post-SAMMPRIS (n= 2080) survey. The 3 surveys were conducted using web-based survey tools delivered by email, and a fax-based response form delivered by email and conventional mail. Data were analyzed using the chi-square test. Pre-WASID, there was equipoise between warfarin and aspirin for stroke prevention in patients with ICAS. The number of respondents who recommended antiplatelet treatment for ICAS increased across all 3 surveys for both anterior circulation (pre-WASID=44%, post-WASID=85%, post-SAMMPRIS=94%) and posterior circulation (pre-WASID=36%, post-WASID=74%, post-SAMMPRIS=83%). The antiplatelet agent most commonly recommended post-WASID was aspirin, but post-SAMMPRIS it was the combination of aspirin and clopidogrel. The percentage of neurologists who recommended PTAS in > 25% of ICAS patients increased slightly from pre-WASID (8%) to post-WASID (12%), but then decreased again post-SAMMPRIS (6%). The percentage of neurointerventionists who recommended PTAS in > 25% of ICAS patients decreased from post-WASID (49%) to post-SAMMPRIS (17%). The surveyed US physicians’ recommended treatments for ICAS differed over the 3 survey periods, reflecting the results of the 2 NIH-funded clinical trials of ICAS and suggesting that these clinical trials changed practice in the US.
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影响因子：
8.3
作者：
GOLDSTEIN, LB;BONITO, AJ;SAMSA, GP
通讯作者：
SAMSA, GP
影响因子：
4.8
作者：
Moskowitz, S. I.;Kelly, M. E.;Fiorella, D.
通讯作者：
Fiorella, D.
影响因子：
8.3
作者：
Gorelick, Philip B.;Wong, Ka Sing;Pandey, Dilip K.
通讯作者：
Pandey, Dilip K.
影响因子：
9.9
作者：
CHIMOWITZ, MI;KOKKINOS, J;FAYAD, PB
通讯作者：
FAYAD, PB
影响因子：
158.5
作者：
Chimowitz, MI;Lynn, MJ;Romano, JG
通讯作者：
Romano, JG