<International Circulation>:  When determining the type of stent (or indeed whether to stent or not as it may be) and being aware of the pros and cons of the options， is this purely a clinician/interventionalist decision?

  《国际循环》：权衡利弊，在支架类型的选择，亦或是放与不放支架的选择面前，仅仅是介入医生在做主观的决策吗？
    Prof Ting: There are different types of medical decisions that need to be made and the type of stent or whether to stent or not， is an example of that. There are two major categories of medical decisions – patient preference-sensitive decisions versus technical decisions. A technical decision is one where a patient is admitted with a gunshot wound or a knife wound or trauma and in the operating room the surgeon is trying to save your life. The decisions are being made on what type of and how many sutures are required and so on. That is a technical decision and you trust the medical team and the surgeon to make the best decisions in the patient’s best interests. That is differentiated from a preference-sensitive decision where there are benefits and risks. There is no right or wrong. In a preference-sensitive decision， the ideal person to make that decision is actually the patient in concert with the clinician where they are sharing risk/benefit knowledge and deciding whether they want to proceed with treatment A or treatment B based on the patient’s own personal preferences and goals. Do I want to take blood thinners for twelve months? Am I willing to put up with a higher risk of restenosis? Can I afford the cost of medication and stents? These decisions concerning drug-eluting stents versus bare-metal stents fall into the category of a preference-sensitive decision where a discussion about the risks and benefits and alternatives ideally occurs between the patient and the clinician.

    Prof Ting: 如何选择支架类型和是否放置支架是一种临床决策，医疗决策中包括：患者决策和技术决策两种。技术决策举例解释可以理解为，一个因枪伤，刀伤或创伤等原因进入手术室的患者，由外科医生会通过选择何种术式和缝多少针来达到挽救病人生命的目的。技术决策就是这样，患者相信医疗小组和外科医生会制定出最适合的治疗方案达到最好的治疗效果。这与患者决策不同，且两者各有利弊。患者决策的决策人是患者本人，他们会通过对A或B治疗方案利弊的了解，自行选择治疗方案以达到自己希望的治疗目标。患者通常会问自己：我能坚持12个月用于稀释血液的药物治疗吗？我能承受支架内再狭窄的高风险吗？我是否能负担药物和支架的高额费用？DES和BMS的选择属于患者决策的范畴，反映了医生和患者对权衡治疗决策利弊的一种认同。

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