Physician Approaches to the Initial Management of an Intraluminal Thrombus in Recently Symptomatic Carotid Artery Stenosis: Results from the Hot Carotid Study (S20.005)
Notice bibliographique
Résumé
Objective: To use mixed methods to explore the practices of international experts when managing patients with an intraluminal carotid artery thrombus in the context of recently symptomatic carotid artery stenosis. Background: Intraluminal thrombi (ILT) are thought to be at high short-term risk of recurrent ischemic events without revascularization and high risk of peri-operative stroke when early revascularization is attempted. Due to the lack of high-quality evidence, ILT management approaches rely on individual or institutional preferences, but the current state of practice is unclear. Design/Methods: This mixed methods study analyzed themes from semi-structured interviews with 22 stroke physicians from 16 centers in 6 world regions, paired with a worldwide case-based survey of 628 stroke physicians conducted through the “Practice Current” section of Neurology: Clinical Practice. Results: In the thematic analysis of the interviews and quantitative analysis of the survey, participants generally favoured using anticoagulation with or without one or more antiplatelet agents at least short-term in patients with ILT (463/628, 74%). Despite a preference for anticoagulation, a theme of uncertainty regarding optimal antithrombotic management was present in the thematic analysis. Multivariable regression analysis of the survey data also showed significant regional variability regarding antithrombotic choices in treating ILT, with the USA and Canada favouring anticoagulation compared to other surveyed regions. Additional themes identified included a preference for re-imaging patients in 3–5 days after initiating treatment to look for complete or partial clot resolution, at which point most experts would then be comfortable proceeding with revascularization if indicated, though significant uncertainty regarding the optimal timing of revascularization was noted in the analysis. Conclusions: These results highlight current practice patterns in patients with ILT and show that while there appears to some preference for using anticoagulant agents and reimaging patients in 3–5 days, there is still considerable equipoise regarding the most appropriate management of patients with ILT. Disclosure: Dr. Maclean has nothing to disclose. Dr. Beland has nothing to disclose. Dr. Jewett has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amylyx Pharmaceuticals. Dr. Jewett has received research support from ALS Canada. Dr. Jewett has received research support from Canadian Institute of Health Research. Dr. Bartolini has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology. David JT Campbell has nothing to disclose. An immediate family member of Dr. Varma has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MD Analytics. An immediate family member of Dr. Varma has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Figure 1. An immediate family member of Dr. Varma has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Atheneum. An immediate family member of Dr. Varma has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CTC Communications Corp. Dr. Varma has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for AHA Health Ltd. An immediate family member of Dr. Varma has received stock or an ownership interest from SnapDx. An immediate family member of Dr. Varma has received stock or an ownership interest from TheRounds.com. The institution of an immediate family member of Dr. Varma has received research support from Canadian Institutes of Health Research. The institution of an immediate family member of Dr. Varma has received research support from Alberta Innovates. The institution of an immediate family member of Dr. Varma has received research support from Sunnybrook Research Institute INOVAIT. The institution of an immediate family member of Dr. Varma has received research support from Canadian Cardiovascular Society. The institution of an immediate family member of Dr. Varma has received research support from Campus Alberta Neuroscience. An immediate family member of Dr. Varma has received intellectual property interests from a discovery or technology relating to health care. An immediate family member of Dr. Varma has a non-compensated relationship as a Editor with Neurology, Neurology: Clinical Practice that is relevant to AAN interests or activities. Dr. Singh has nothing to disclose. Dr. Al Sultan has nothing to disclose. Dr. Wong has received stock or an ownership interest from Fluid Biotech Inc.. Dr. Wong has received intellectual property interests from a discovery or technology relating to health care. Dr. Menon has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen. Dr. Menon has received personal compensation in the range of $500-$4,999 for serving on a Speakers Bureau for Roche. Dr. Menon has received personal compensation in the range of $0-$499 for serving as an officer or member of the Board of Directors for Circle NVI. Dr. Menon has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke VIN. Dr. Menon has stock in Circle NVI. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MD Analytics. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for MyMedicalPanel. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Figure 1. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for DeepBench. An immediate family member of Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for CTC Communications Corp. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Atheneum. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Research on Mind. Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as a Consultant for Creative Research Designs. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Alexion. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Biogen. Dr. Ganesh has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Academy of Neurology (journals Neurology and Neurology: Clinical Practice). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Heart Association (journal: Stroke). Dr. Ganesh has received personal compensation in the range of $0-$499 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Frontiers (for Frontiers in Neurology). Dr. Ganesh has stock in SnapDx. Dr. Ganesh has stock in TheRounds.com. Dr. Ganesh has stock in Advanced Health Analytics (AHA Health Ltd). Dr. Ganesh has stock in Collavidence Inc. The institution of Dr. Ganesh has received research support from Canadian Institutes of Health Research . The institution of Dr. Ganesh has received research support from Canadian Cardiovascular Society. The institution of Dr. Ganesh has received research support from Alberta Innovates. The institution of Dr. Ganesh has received research support from University of Calgary Centre for Clinical Research. The institution of Dr. Ganesh has received research support from Innovation 4 Health. The institution of Dr. Ganesh has received research support from Sunnybrook Research Institute INOVAIT. The institution of Dr. Ganesh has received research support from Campus Alberta Neurosciences. The institution of Dr. Ganesh has received research support from Alzheimer Society of Canada. The institution of Dr. Ganesh has received research support from Heart and Stroke Foundation of Canada. The institution of Dr. Ganesh has received research support from New Frontiers in Research Fund. The institution of Dr. Ganesh has received research support from Panmure House. Dr. Ganesh has received intellectual property interests from a discovery or technology relating to health care.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,010 | 0,021 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,002 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,001 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».