From Klinik und Poliklinik für Neurologie (D.L.R., A.C.A., T.M., C.G., G.T.) and Klinik und Poliklinik für Neurochirurgie (N.O.S., J.R.), Kopf- und Neurozentrum, and Klinik und Poliklinik für Neuroradiologische Diagnostik und Intervention, Diagnostikzentrum (J.F.), Universitätsklinikum Hamburg-Eppendorf; Klinik für Gefäβmedizin (A.L.-A., E.S.D.), Universitäres Herzzentrum Hamburg; Klinik für Neurologie und Neurologische Frührehabilitation (M.R.), Albertinen-Krankenhaus, Hamburg, Germany; Swiss Federal Institute of Technology (EPFL) (F.C.H.), Campus Biotech, Geneva; and Clinique Romande de Réadaptation (F.C.H.), Sion, Switzerland.
Neurology. 2017 Jul 25;89(4):399-407. doi: 10.1212/WNL.0000000000004151. Epub 2017 Jun 28.
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.
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.
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.
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.
描述我们在多学科神经血管委员会中，由神经科医生、介入神经放射学家、血管外科医生和神经外科医生基于共识的决策方法治疗颈内动脉（ICA）狭窄的经验，并研究在最佳治疗选择存在不确定性的情况下，治疗建议的遵循情况。
我们每周两次举行多学科神经血管委员会会议，对共识决策进行结构化记录。在 53 个月的时间内，共讨论了 614 例 ICA 狭窄病例，其中 285 例（46%）为症状性，279 例（45%）为无症状性。
对于症状性 ICA 狭窄，建议进行血运重建的占 76%，单独药物治疗的占 8%，进一步诊断的占 16%。对于无症状性 ICA 狭窄，建议进行临床试验随机分组的占 29%，血运重建的占 27%，单独药物治疗的占 23%，进一步诊断的占 22%。症状性 ICA 狭窄的治疗建议遵循率为 94%，无症状性 ICA 狭窄的治疗建议遵循率为 69%。推荐进行颈动脉支架置入术血运重建的患者年龄较小，且 ICA 狭窄程度更严重（≥70%）。
多学科委员会决策是一种有用且透明的工具，可以确保指南推荐的遵循，并在缺乏明确证据的情况下，为临床实践提供基于共识的个体化治疗策略。
