专业对内血管实践模式和BEST-CLI试验结果的影响
Richard J Powell1, Matthew T Menard2, Kenneth Rosenfield3
1Dartmouth Health Heart and Vascular Center, Geisel School of Medicine at Dartmouth, Dartmouth Hitchcock Medical Center, Lebanon, NH.
Journal of vascular surgery
|November 8, 2025
概括
干预放射科医生 (IR) 在慢性四肢威胁性缺血症 (CLTI) 的BEST-CLI试验中表现更好,与干预心脏病专家 (IC) 和血管外科医生 (VS) 相比. 在IR中,主要的不良肢体事件和死亡较少,截肢率没有差异.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 干预性放射学 干预性放射学
- 血管内治疗疗法 血管内疗法
- 慢性四肢威胁性缺血症 (CLTI) 是一种疾病.
背景情况:
- 在BEST-CLI试验中,对 CLTI 患者进行内血管治疗 (EVT) 和开放式手术治疗进行了比较.
- 本分析侧重于不同专业的EVT部门的实践模式和结果:干预心脏病学家 (IC),干预放射学家 (IR) 和血管外科医生 (VS).
研究的目的:
- 在BEST-CLI试验中,评估IC,IR和VS之间内血管实践模式的差异.
- 为了比较临床结果,包括主要不良肢体事件 (MALE) 和死亡 (MALE-death),在进行CLTI的EVT的专业之间.
主要方法:
- 分析包括在BEST-CLI试验中通过认证的IC,IR和VS进行EVT的患者.
- 人口统计和实践模式使用差异分析进行了比较.
- 主要终点:男性死亡. 二级终点包括重重血管,截肢和死亡.
主要成果:
- 血管外科医生治疗了大多数EVT患者,更频繁的是那些严重缺血 (3级) 患者.
- 干预性心脏病学家使用更多的P2Y12抑制剂,克洛皮多格雷尔,双抗血小板疗法,并更频繁地治疗小腿动脉,采用切除术,药物涂层气球和药物排泄支架.
- 与ICs和VSs相比,干预放射科医生显示MALE死亡的发生率明显较低 (由较低的死亡率和主要再血管化率驱动). 专业之间没有观察到截肢率的显著差异.
结论:
- 实践模式和患者特征在IC,IR和VS之间存在显著的差异,这些IC,IR和VS在CLTI进行EVT.
- 与干预性心脏病专家和血管外科医生相比,干预性放射科医生在MALE死亡和总死亡率方面表现出更好的结果.
- 尽管结果有差异,截肢率在各专业之间是可比的,这凸显了对实践变化的进一步调查的需要.
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