Acute Outcomes & Management of TIA with Carotid Disease

急性后果

• 批准号: 7050624
• 负责人: MAI N NGUYEN-HUYNH
• 金额: $ 16.14万
• 依托单位: UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-04-15 至 2010-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7050624
• 关键词: angiocardioultrasonography; artery stenosis; atherosclerosis; cardiovascular disorder diagnosis; cardiovascular disorder prevention; cardiovascular disorder risk; carotid artery; clinical research; cost effectiveness; endarterectomy; gender difference; human data; outcomes research; patient care management; patient oriented research; postoperative state; stroke; transient ischemic attack

DESCRIPTION (provided by applicant): As the costs of healthcare continue to rise, healthcare policy makers and physicians are pushing for more evidence-based medical decision-making. Medical technology and interventions have to be proven that they not only improve quality of life but also are cost-effective. Consequently, the overall goal of this proposed program is to provide Dr. Nguyen-Huynh with didactic teaching in study design, database management, multivariate and cost-effectiveness analyses, along with mentoring and clinical duties, to enable her development as an independent investigator in cerebrovascular medicine. Her project on acute outcome and management of TIA with carotid disease will provide her the chance to apply her new skills and knowledge. Atherosclerotic disease in the internal carotid artery (ICA) is a common cause of stroke and TIA. Clinical trials have demonstrated a clear benefit of carotid endarterectomy (CEA) over medical management in patients with TIA or minor stroke and severe ICA stenosis. In addition, studies have found the short-term stroke risk after TIA to be substantial. These results would suggest that an urgent carotid ultrasound should be done in all appropriate TIA patients and potentially an endarterectomy if severe disease is found. Current guidelines for the management of TIA patients recommend a carotid artery examination, but do not specify the timeframe for which this diagnostic evaluation should be carried out. We propose a series of studies to examine the need for an urgent diagnostic work-up and management of TIA patients with severe carotid disease. These studies will include: 1) a stroke-free survival analysis of a large cohort of TIA patients with severe ICA stenosis compared to those without severe disease; 2) a retrospective cohort study of TIA patients who underwent CEA to determine the surgical risks of "early" (equal to or less than 30 days after incident TIA) vs. "delayed" (more than 30 days) surgery using multivariate analysis; 3) a cost-effectiveness analysis of "urgent" carotid ultrasound after a TIA. The results of these studies will provide physicians with evidence-based recommendations, and will foster Dr. Nguyen-Huynh's career as an independent clinical investigator in cerebrovascular diseases.

描述(由申请人提供)： 随着医疗成本的持续上升，医疗政策制定者和医生正在推动更多基于证据的医疗决策。必须证明，医疗技术和干预措施不仅提高了生活质量，而且具有成本效益。因此，这个拟议项目的总体目标是为阮慧博士提供研究设计、数据库管理、多变量和成本效益分析方面的教学指导，以及指导和临床职责，使她能够发展成为脑血管内科的独立研究员。她关于TIA合并颈动脉疾病的急性结局和管理的项目将为她提供应用新技能和知识的机会。颈内动脉粥样硬化性疾病(ICA)是中风和短暂性脑缺血发作的常见原因。临床试验表明，颈动脉内膜剥脱术(CEA)在TIA或轻度卒中和严重颈内动脉狭窄患者中明显优于内科治疗。此外，研究发现短暂性脑缺血发作后的短期中风风险很大。这些结果表明，所有合适的TIA患者都应该进行紧急颈动脉超声检查，如果发现严重疾病，还可能进行动脉内膜切除术。目前短暂性脑缺血发作患者的治疗指南建议进行颈动脉检查，但没有具体说明应该对其进行诊断评估的时间框架。我们建议进行一系列研究，以检验对患有严重颈动脉疾病的短暂性脑缺血发作患者进行紧急诊断和治疗的必要性。这些研究将包括：1)有严重ICA狭窄的TIA患者与无严重疾病的TIA患者进行的无中风生存对比分析；2)采用多因素分析对接受CEA治疗的TIA患者进行回顾性队列研究，以确定“早期”(等于或少于TIA发生后30天)与“延迟”(超过30天)手术的手术风险；3)TIA术后“紧急”颈动脉超声检查的成本-效果分析。这些研究的结果将为医生提供循证的建议，并将促进阮慧博士作为脑血管疾病独立临床研究员的职业生涯。