Improving practice through neurovascular board

Management of cervical internal carotid artery (ICA) stenosis remains contentious despite numerous randomized trials and observational studies over the decades since the first report of carotid endarterectomy. Rimmele et al.1 in this issue of Neurology® summarize the 53-month experience of deliberations by a Neurovascular Board at the University Medical Center, Hamburg-Eppendorf (UKE), on management of ICA disease. The multidisciplinary board of senior vascular specialists reviewed 614 cases. The board recommended revascularization in 76% of symptomatic cases and in 27% of asymptomatic cases and encouraged trial participation for a subset of asymptomatic cases. Recommendations appeared well-supported by evidence-based practice guidelines. The authors conclude that the board recommendations provided a helpful and transparent tool to assure adherence to guidelines. However, the study lacked a control group; therefore it is not possible to determine if the board actions truly helped promote evidence-based practice or trial participation. Cluster randomization design might have provided robust evidence for neurovascular boards in a sufficiently brief time frame to avoid the challenge of guideline drift during the study.
Source: Neurology - Category: Neurology Authors: Tags: Stroke prevention EDITORIALS Source Type: research