Management Approaches to Intraluminal Thrombi in Acutely Symptomatic Carotid Stenosis

被引：0
作者：
Maclean, Davis [1 ,2 ]
Beland, Benjamin [2 ]
Jewett, Gordon A. E. [2 ]
Bartolini, Luca [3 ]
Campbell, David J. T. [1 ,4 ,5 ]
Varma, Malavika [1 ,2 ]
Singh, Ravinder-Jeet [6 ]
Wong, John H. [1 ]
Menon, Bijoy K. [1 ,4 ,7 ,8 ]
Ganesh, Aravind [1 ,4 ,7 ]
机构：
[1] Univ Calgary, Dept Clin Neurosci, Stroke Program, Cumming Sch Med, Calgary, AB, Canada
[2] Univ Calgary, Dept Med, Cumming Sch Med, Calgary, AB, Canada
[3] Brown Univ, Hasbro Childrens Hosp, Neurol & Neurosurg Warren Alpert Med Sch, Dept Pediat,Pediat Epilepsy Program, Providence, RI USA
[4] Univ Calgary, Dept Community Hlth Sci, Cumming Sch Med, Calgary, AB, Canada
[5] Univ Calgary, Dept Cardiac Sci, Cumming Sch Med, Calgary, AB, Canada
[6] Northern Ontario Sch Med Univ, Div Clin Sci, Sudbury, ON, Canada
[7] Univ Calgary, Hotchkiss Brain Inst, Calgary, AB, Canada
[8] Univ Calgary, Dept Radiol, Cumming Sch Med, Calgary, AB, Canada
来源：
CANADIAN JOURNAL OF NEUROLOGICAL SCIENCES | 2024年
关键词：
Carotid artery disease; carotid endarterectomy; cerebrovascular disease; stroke; vascular neurology; QUALITATIVE RESEARCH; SAMPLE-SIZE; RISK; STROKE; ENDARTERECTOMY; ARTERY; INTERVIEW;
D O I：
10.1017/cjn.2024.348
中图分类号：
R74 [神经病学与精神病学];
学科分类号：
摘要：
Background: The presence of an intraluminal thrombus in acutely symptomatic carotid stenosis is thought to represent a high-risk lesion for short-term stroke reccurrence though evidence on natural history and treatment is lacking, leading to equipoise and much variation in practice. The objective of this study was to map these variations in practice (medical management and timing of revascularization), determine the considerations that influence clinician decision-making in this condition and gather opinions that inform the development and design of future trials in the area. Methods: This was a mixed-methods study using both quantitative survey methods and qualitative interview-based methods. International perspectives were gathered by distributing a case-based survey via the "Practice Current" section of Neurology: Clinical Practice and interviewing international experts using established qualitative research methods. Results: The presence of an intraluminal thrombus significantly increased the likelihood of using a regimen containing anticoagulation agents (p < 0.001) in acutely symptomatic carotid stenosis in the case-based survey. Themes that emerged from qualitative interview analysis were therapeutic uncertainty regarding anticoagulation, decision to reimage, revascularization choices and future trial design and anticipated challenges. Conclusion: Results of this study demonstrate a preference for anticoagulation and delayed revascularization after reimaging to examine for clot resolution, though much equipoise remains. While there is interest from international experts in future trials, further study is needed to understand the natural history of this condition in order to inform trial design.
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页数：8
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