TY - JOUR T1 - Patient-Relevant Deficits Dictate Endovascular Thrombectomy Decision-Making in Patients with Low NIHSS Scores with Medium-Vessel Occlusion Stroke JF - American Journal of Neuroradiology JO - Am. J. Neuroradiol. SP - 1834 LP - 1838 DO - 10.3174/ajnr.A7253 VL - 42 IS - 10 AU - R. McDonough AU - P. Cimflova AU - N. Kashani AU - J.M. Ospel AU - M. Kappelhof AU - N. Singh AU - A. Sehgal AU - N. Sakai AU - J. Fiehler AU - M. Chen AU - M. Goyal Y1 - 2021/10/01 UR - http://www.ajnr.org/content/42/10/1834.abstract N2 - BACKGROUND AND PURPOSE: There is a paucity of evidence regarding the safety of endovascular treatment for patients with acute ischemic stroke due to primary medium-vessel occlusion. The aim of this study was to examine the willingness among stroke physicians to perform endovascular treatment in patients with mild-yet-disabling deficits due to medium-vessel occlusion.MATERIALS AND METHODS: In an international cross-sectional survey consisting of 7 primary medium-vessel occlusion case scenarios, participants were asked whether the presence of personally disabling deficits would influence their decision-making for endovascular treatment despite the patients having low NIHSS scores (<6). Decision rates were calculated on the basis of physician characteristics. Univariable logistic regression clustered by respondent and scenario identity was performed.RESULTS: Three hundred sixty-six participants from 44 countries provided 2562 answers to the 7 medium-vessel occlusion scenarios included in this study. In scenarios in which the deficit was relevant to the patient's profession, 56.9% of respondents opted to perform immediate endovascular treatment compared with 41.0% when no information regarding the patient's profession was provided (risk ratio = 1.39, P < .001). The largest effect sizes were seen for female participants (risk ratio = 1.68; 95% CI, 1.35–2.09), participants older than 60 years of age (risk ratio = 1.61; 95% CI, 1.23–2.10), those with more experience in neurointervention (risk ratio = 1.60; 95% CI, 1.24–2.06), and those who personally performed >100 endovascular treatments per year (risk ratio = 1.63; 95% CI, 1.22–2.17).CONCLUSIONS: The presence of a patient-relevant deficit in low-NIHSS acute ischemic stroke due to medium-vessel occlusion is an important factor for endovascular treatment decision-making. This may have relevance for the conduct and interpretation of low-NIHSS endovascular treatment in randomized trials.AISacute ischemic strokeEVTendovascular therapyRRrisk ratioMeVOmedium-vessel occlusion ER -