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首页> 外文期刊>Journal of stroke and cerebrovascular diseases: The official journal of National Stroke Association >Is There Equipoise Regarding the Optimal Medical Treatment of Patients with Asymptomatic White Matter Hyperintensities?
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Is There Equipoise Regarding the Optimal Medical Treatment of Patients with Asymptomatic White Matter Hyperintensities?

机译：有关无症状白质超收缩患者的最佳医疗有价值吗？

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Background: 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 Stroke-Net to better understand neurologist attitudes about asymptomatic WMH. Methods: 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." Results: 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. Conclusions: 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.
机译：背景：白质超强度（WMH）是慢性缺血性微血管疾病的常见表现，使其具有更大的功能性残疾，中风和痴呆的风险。 Sprint Mind最近报道，强化血压降低导致轻度认知障碍和WMH进展的较低率，这表明医疗干预措施可能对WMH产生可衡量的影响。我们对Ninds中风的提供者进行了匿名调查，以更好地了解神经病学家对无症状WMH的态度。方法：我们向29个区域协调中心向Strokenet的29个区域协调中心发送了一个7个问题的调查，其协调员向供应商传播给提供者的调查“在他们中风后参与了患者。”结果：我们收到了136个回复。对于卒中预防疗法，包括阿司匹林和他汀类药物治疗和血压靶，存在大规模的等级，没有单一选择接受> 50％的认可，介于15-32％的受访者之间，选择“不确定”的选择。 83％的受访者表明对针对这一患者人口的试验的高度或适度的热情。降低缺血性卒中，认知障碍或痴呆的临床结果很高（> 70％的认可），而剩余的射线照相，安全性和临床终点都未能达到50％的认可。结论：我们的调查建立了有意义的神经病学家态度，可以告知未来的WMH研究。对于患有无症状WMH和Stokett的提供者的最佳治疗有相当大的Quipoise，他们将成为美国威力研究的重要利益攸关方，热情地支持临床试验，以解决最优医学管理的开放性问题。

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