Research ExplorerPublicationsReal-world experience of treatment decision-making in caroti...

Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board

Standard

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, Vol. 89, No. 4, 25.07.2017, p. 399-407.

Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review

Harvard

Rimmele, DL, Larena-Avellaneda, A, Alegiani, AC, Rosenkranz, M, Schmidt, NO, Regelsberger, J, Hummel, FC, Magnus, T, Debus, ES, Fiehler, J, Gerloff, C & Thomalla, G 2017, 'Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board', NEUROLOGY, vol. 89, no. 4, pp. 399-407. https://doi.org/10.1212/WNL.0000000000004151

APA

Rimmele, D. L., Larena-Avellaneda, A., Alegiani, A. C., Rosenkranz, M., Schmidt, N. O., Regelsberger, J., Hummel, F. C., Magnus, T., Debus, E. S., Fiehler, J., Gerloff, C., & Thomalla, G. (2017). Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board. NEUROLOGY, 89(4), 399-407. https://doi.org/10.1212/WNL.0000000000004151

Vancouver

Rimmele DL, Larena-Avellaneda A, Alegiani AC, Rosenkranz M, Schmidt NO, Regelsberger J et al. Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board. NEUROLOGY. 2017 Jul 25;89(4):399-407. https://doi.org/10.1212/WNL.0000000000004151

Bibtex

@article{cad173bba77245efa7e26ccea0d23c68,
title = "Real-world experience of treatment decision-making in carotid stenosis in a neurovascular board",
abstract = "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.",
keywords = "Age Factors, Aged, Carotid Artery, Internal, Carotid Stenosis, Cerebral Revascularization, Clinical Decision-Making, Consensus, Female, Guideline Adherence, Humans, Male, Patient Care Team, Practice Guidelines as Topic, Precision Medicine, Stents, Journal Article",
author = "Rimmele, {David Leander} and Axel Larena-Avellaneda and Alegiani, {Anna C} and Michael Rosenkranz and Schmidt, {Nils Ole} and Jan Regelsberger and Hummel, {Friedhelm C} and Tim Magnus and Debus, {Eike Sebastian} and Jens Fiehler and Christian Gerloff and G{\"o}tz Thomalla",
note = "{\textcopyright} 2017 American Academy of Neurology.",
year = "2017",
month = jul,
day = "25",
doi = "10.1212/WNL.0000000000004151",
language = "English",
volume = "89",
pages = "399--407",
journal = "NEUROLOGY",
issn = "0028-3878",
publisher = "Lippincott Williams and Wilkins",
number = "4",

}

RIS

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 -