University of Utah, Department of Neurology, Salt Lake City, Utah.
Department of Neurology, Feinberg School of Medicine, Chicago, Illinois.
J Stroke Cerebrovasc Dis. 2019 Nov;28(11):104371. doi: 10.1016/j.jstrokecerebrovasdis.2019.104371. Epub 2019 Sep 5.
White matter hyperintensity (WMH) is a common manifestation of chronic ischemic microvascular disease that heralds greater risk of functional disability, stroke, and dementia. SPRINT MIND recently reported that intensive blood pressure reduction resulted in lower rates of mild cognitive impairment and WMH progression, suggesting that medical interventions could have a measurable impact on WMH. We conducted an anonymous survey of providers in the NINDS StrokeNet to better understand neurologist attitudes about asymptomatic WMH.
We sent a 7-question survey to the 29 Regional Coordinating Centers of the StrokeNet, whose coordinators disseminated the survey to providers "involved in the care of a patient after their stroke."
We received 136 responses. For stroke prevention therapies, including aspirin and statin therapy and blood pressure target, there was substantial equipoise, with no single option receiving >50% endorsement and between 15-32% of respondents choosing the option of "not sure." 83% of respondents indicated high or moderate enthusiasm for a trial targeting this patient population. The clinical outcomes of reduction in ischemic stroke, cognitive impairment, or dementia were high importance (>70% endorsement), while the remaining radiographic, safety, and clinical endpoints all failed to reach 50% endorsement.
Our survey establishes meaningful neurologist attitudes that can inform future WMH research. There is considerable equipoise regarding optimal medical treatment for patients with asymptomatic WMH and providers in StrokeNet, who would be a vital stakeholder in WMH research in the United States, enthusiastically support a clinical trial to resolve open questions on optimal medical management.
脑白质高信号（WMH）是慢性缺血性微血管病的常见表现，预示着更高的功能残疾、中风和痴呆风险。SPRINT MIND 最近报告称，强化降压可降低轻度认知障碍和 WMH 进展的发生率，这表明医学干预可能对 WMH 产生可衡量的影响。我们对 NINDS StrokeNet 的提供者进行了一项匿名调查，以更好地了解神经科医生对无症状性 WMH 的态度。
我们向 StrokeNet 的 29 个区域协调中心发送了一份包含 7 个问题的调查问卷，其协调员将问卷分发给“参与中风后患者护理的提供者”。
我们收到了 136 份回复。对于预防中风的治疗方法，包括阿司匹林和他汀类药物治疗以及血压目标，存在很大的均衡性，没有任何一种选择得到超过 50%的认可，15-32%的受访者选择了“不确定”的选项。83%的受访者表示对针对这一患者群体的试验有很高或中等的热情。降低缺血性中风、认知障碍或痴呆的临床结局非常重要（>70%的认可），而其余的影像学、安全性和临床终点都没有达到 50%的认可。
我们的调查确立了有意义的神经科医生态度，可以为未来的 WMH 研究提供信息。对于无症状性 WMH 患者的最佳药物治疗，以及 StrokeNet 的提供者，存在相当大的均衡性，他们将是美国 WMH 研究的重要利益相关者，热情支持一项临床试验，以解决最佳药物管理方面的未决问题。
