Acute Outcomes & Management of TIA with Carotid Disease

急性后果

• 批准号: 7216371
• 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/7216371
• 关键词: Accident and Emergency department; Acute; Affect; American Heart Association; Carotid Arteries; Carotid Endarterectomy; Cerebrovascular Disorders; Cessation of life; Clinical; Clinical Investigator; Clinical Trials; Cohort Studies; Cost Effectiveness Analysis; Databases; Day Surgery; Decision Making; Development; Diagnosis; Diagnostic; Disease; Educational process of instructing; Endarterectomy; Etiology; Evaluation; Fostering; Future; Goals; Guidelines; Health Care Costs; Health Maintenance Organizations; Health Services Research; Healthcare; Hospitalization; Hour; Image; Incidence; Internal Carotid Artery Stenosis; Internal carotid artery structure; Intervention; Knowledge; Lead; Medical; Medical Technology; Medicine; Mentors; Minor; Multivariate Analysis; Neurologist; Operative Surgical Procedures; Outcome; Patients; Physicians; Play; Policy Maker; Prevalence; Quality of life; Randomized Controlled Clinical Trials; Research; Research Design; Research Personnel; Risk; Role; Series; Specific qualifier value; Stenosis; Stroke; Survival Analysis; Testing; Time; Transient Ischemic Attack; Ultrasonography; Work; base; career; cerebrovascular; cohort; cost; cost effective; cost effectiveness; day; design; evidence based guidelines; improved; outcome forecast; programs; skills

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）： 随着医疗保健成本的持续上升，医疗保健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能提高生活质量，而且具有成本效益。因此，该计划的总体目标是为Nguyen-Huynh博士提供研究设计、数据库管理、多元和成本效益分析方面的教学，沿着指导和临床职责，使她能够发展成为脑血管医学的独立研究者。她的急性结果和TIA与颈动脉疾病的管理项目将为她提供应用她的新技能和知识的机会。颈内动脉（伊卡）中的动脉粥样硬化疾病是中风和TIA的常见原因。临床试验表明，在TIA或轻微卒中和严重伊卡狭窄患者中，颈动脉内膜切除术（CEA）明显优于药物治疗。此外，研究发现TIA后短期中风风险很大。这些结果表明，紧急颈动脉超声应在所有适当的TIA患者和可能的动脉内膜切除术，如果发现严重的diseases. Current指南TIA患者的管理建议颈动脉检查，但没有指定的时间框架，这种诊断评估应进行。我们提出了一系列的研究，以检查是否需要一个紧急的诊断工作和管理TIA患者的严重颈动脉疾病。这些研究将包括：1）与无严重疾病的TIA患者相比，对患有严重伊卡狭窄的TIA患者的大型队列进行无卒中生存分析; 2）对接受CEA的TIA患者进行回顾性队列研究，以确定“早期”手术风险。（TIA事件发生后等于或少于30天）与“延迟”（30天以上）手术的多变量分析; 3）TIA后“紧急”颈动脉超声的成本-效果分析。这些研究的结果将为医生提供基于证据的建议，并将促进Nguyen-Huynh博士作为脑血管疾病独立临床研究者的职业生涯。