■秘密脑梗死(CBI)非常普遍,并且与中风风险因素有关,死亡率增加,和发病率。指导管理的证据很少。我们试图获得有关当前实践和对CBI态度的信息,并根据CBI表型比较管理差异。
■我们进行了基于网络的,结构化,2021年11月至2022年2月在神经学家和神经放射学家中进行的国际调查。调查捕捉到了受访者的基线特征,CBI的一般方法包括两个病例方案,用于评估偶然发现栓塞表型和小血管疾病表型时的管理决策.
■在627名受访者中(38%的血管神经科医生,24%的普通神经科医生,和26%的神经放射学家),362(58%)有部分,和305(49%)一个完整的响应。大多数受访者是有中风经验的大学医院高级教员,主要来自欧洲和亚洲。只有66(18%)的受访者建立了机构书面协议来管理CBI。大多数人表示,他们不确定CBI患者的有用调查和进一步管理(滑块0-100的中位数67,95%CI35-81)。几乎所有受访者(97%)表示他们将评估血管危险因素。尽管大多数人会对两种表型的缺血性卒中进行类似的研究和治疗,包括开始抗血栓治疗,存在相当大的诊断和治疗异质性.不到一半的受访者(42%)会评估认知功能或抑郁症。
■关于两种常见类型的CBI的管理存在高度的不确定性和异质性,甚至在经验丰富的中风医生中。与当前专家意见所建议的最低要求相比,受访者对诊断和治疗管理更为主动。需要更多的数据来指导CBI的管理;同时,更一致的方法来识别和一致地应用当前知识,也考虑到认知和情绪,将是改善护理一致性的第一步。
UNASSIGNED: Covert brain infarction (CBI) is highly prevalent and linked with stroke risk factors, increased mortality, and morbidity. Evidence to guide management is sparse. We sought to gain information on current practice and attitudes toward CBI and to compare differences in management according to CBI phenotype.
UNASSIGNED: We conducted a web-based, structured, international survey from November 2021 to February 2022 among
neurologists and neuroradiologists. The survey captured respondents\' baseline characteristics, general approach toward CBI and included two case scenarios designed to evaluate management decisions taken upon incidental detection of an embolic-phenotype and a small-vessel-disease phenotype.
UNASSIGNED: Of 627 respondents (38% vascular
neurologists, 24% general
neurologists, and 26% neuroradiologists), 362 (58%) had a partial, and 305 (49%) a complete response. Most respondents were university hospital senior faculty members experienced in stroke, mostly from Europe and Asia. Only 66 (18%) of respondents had established institutional written protocols to manage CBI. The majority indicated that they were uncertain regarding useful investigations and further management of CBI patients (median 67 on a slider 0-100, 95% CI 35-81). Almost all respondents (97%) indicated that they would assess vascular risk factors. Although most would investigate and treat similarly to ischemic stroke for both phenotypes, including initiating antithrombotic treatment, there was considerable diagnostic and therapeutic heterogeneity. Less than half of respondents (42%) would assess cognitive function or depression.
UNASSIGNED: There is a high degree of uncertainty and heterogeneity regarding management of two common types of CBI, even among experienced stroke physicians. Respondents were more proactive regarding the diagnostic and therapeutic management than the minimum recommended by current expert opinions. More data are required to guide management of CBI; meantime, more consistent approaches to identification and consistent application of current knowledge, that also consider cognition and mood, would be promising first steps to improve consistency of care.