Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board
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Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board. / Rimmele, David Leander; Larena-Avellaneda, Axel; Alegiani, Anna C; Rosenkranz, Michael; Schmidt, Nils Ole; Regelsberger, Jan; Hummel, Friedhelm C; Magnus, Tim; Debus, Eike Sebastian; Fiehler, Jens; Gerloff, Christian; Thomalla, Götz.
in: NEUROLOGY, Jahrgang 89, Nr. 4, 25.07.2017, S. 399-407.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board
AU - Rimmele, David Leander
AU - Larena-Avellaneda, Axel
AU - Alegiani, Anna C
AU - Rosenkranz, Michael
AU - Schmidt, Nils Ole
AU - Regelsberger, Jan
AU - Hummel, Friedhelm C
AU - Magnus, Tim
AU - Debus, Eike Sebastian
AU - Fiehler, Jens
AU - Gerloff, Christian
AU - Thomalla, Götz
N1 - © 2017 American Academy of Neurology.
PY - 2017/7/25
Y1 - 2017/7/25
N2 - OBJECTIVE: To describe our experience with consensus-based decision-making for treatment of internal carotid artery (ICA) stenosis by neurologists, interventional neuroradiologists, vascular surgeons, and neurosurgeons in a multidisciplinary neurovascular board and to study adherence to treatment recommendations in the context of uncertainty with respect to the best treatment option.METHODS: We established a multidisciplinary neurovascular board meeting twice a week with structured documentation of consensus decisions. Over a time period of 53 months, 614 cases with ICA stenosis were discussed, with 285 (46%) symptomatic and 279 (45%) asymptomatic cases.RESULTS: Recommendation for symptomatic ICA stenosis was revascularization in 76%, medical management alone in 8%, and further diagnostics in 16%. For asymptomatic ICA stenosis, recommendation was randomization in a clinical trial in 29%, revascularization in 27%, medical management alone in 23%, and further diagnostics in 22%. Treatment recommendations were followed in 94% of symptomatic ICA stenosis and 69% of asymptomatic ICA stenosis. Patients in whom carotid artery stenting was recommended for revascularization were younger and showed a higher rate of severe (≥70%) ICA stenosis.CONCLUSIONS: Interdisciplinary board decisions are a helpful and transparent tool to assure adherence to guideline recommendations, and to provide consensus-based individualized treatment strategies in clinical practice in the absence of unequivocal evidence.
AB - OBJECTIVE: To describe our experience with consensus-based decision-making for treatment of internal carotid artery (ICA) stenosis by neurologists, interventional neuroradiologists, vascular surgeons, and neurosurgeons in a multidisciplinary neurovascular board and to study adherence to treatment recommendations in the context of uncertainty with respect to the best treatment option.METHODS: We established a multidisciplinary neurovascular board meeting twice a week with structured documentation of consensus decisions. Over a time period of 53 months, 614 cases with ICA stenosis were discussed, with 285 (46%) symptomatic and 279 (45%) asymptomatic cases.RESULTS: Recommendation for symptomatic ICA stenosis was revascularization in 76%, medical management alone in 8%, and further diagnostics in 16%. For asymptomatic ICA stenosis, recommendation was randomization in a clinical trial in 29%, revascularization in 27%, medical management alone in 23%, and further diagnostics in 22%. Treatment recommendations were followed in 94% of symptomatic ICA stenosis and 69% of asymptomatic ICA stenosis. Patients in whom carotid artery stenting was recommended for revascularization were younger and showed a higher rate of severe (≥70%) ICA stenosis.CONCLUSIONS: Interdisciplinary board decisions are a helpful and transparent tool to assure adherence to guideline recommendations, and to provide consensus-based individualized treatment strategies in clinical practice in the absence of unequivocal evidence.
KW - Age Factors
KW - Aged
KW - Carotid Artery, Internal
KW - Carotid Stenosis
KW - Cerebral Revascularization
KW - Clinical Decision-Making
KW - Consensus
KW - Female
KW - Guideline Adherence
KW - Humans
KW - Male
KW - Patient Care Team
KW - Practice Guidelines as Topic
KW - Precision Medicine
KW - Stents
KW - Journal Article
U2 - 10.1212/WNL.0000000000004151
DO - 10.1212/WNL.0000000000004151
M3 - SCORING: Journal article
C2 - 28659428
VL - 89
SP - 399
EP - 407
JO - NEUROLOGY
JF - NEUROLOGY
SN - 0028-3878
IS - 4
ER -