一个国际,多专业,基于专家的德尔菲共识文件,涉及无症状和症状性动脉狭窄症患者管理中的有争议的问题
Kosmas I Paraskevas1, Dimitri P Mikhailidis2, Peter Arthur Ringleb3
1Department of Vascular Surgery, Central Clinic of Athens, Athens, Greece.
Journal of vascular surgery
|November 9, 2023
概括
这种专家的共识降低了在症状和无症状的动脉狭窄时进行动脉干预的中风风险值. 它还完善了最近症状的定义,并确定了重血管化决定的关键因素.
科学领域:
- 血管外科 血管外科
- 神经学 神经学
- 干预心脏病学 干预心脏病学
背景情况:
- 动脉狭窄症的管理指南往往会让临床问题没有答案.
- 无症状的 (AsxCS) 和症状的 (SxCS) 冠状动脉狭窄症需要临床医生明确的决策框架.
研究的目的:
- 通过国际,多专业的德尔菲共识,解决管狭窄症管理中的未解决问题.
- 在指导方针不清楚的情况下,为临床决策提供专家指导的建议.
主要方法:
- 一个三轮的德尔菲共识进程,涉及61名国际专家.
- 确定了14个在动脉狭窄管理中的有争议的话题.
- 共识定义为≥75%的参与专家达成一致.
主要成果:
- 达成协议,降低心血管干预中风/死亡门:4% (SxCS) 和2% (AsxCS).
- 将"最近出现症状"的门降低到≤3个月.
- 在80-99%的AsxCS中,已知的中风风险较高,而在60-79%的AsxCS中,风险较高.
- 倡导将斑块特征和静音心脏病发作纳入AxxCS复血管化决策.
- 建议在动脉干预期间选择性使用分流.
结论:
- 德尔菲共识提供了有关动脉狭窄管理的几个关键方面的专家指导.
- 尚未解决的主题突出显示,需要在动脉狭窄症治疗的特定领域进行进一步研究.
- 这种共识有助于临床医生在指导方针模糊时管理AsxCS和SxCS.
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