RT Journal Article
SR Electronic
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.
FD American Society of Neuroradiology
DO 10.3174/ajnr.A7253
A1 R. McDonough
A1 P. Cimflova
A1 N. Kashani
A1 J.M. Ospel
A1 M. Kappelhof
A1 N. Singh
A1 A. Sehgal
A1 N. Sakai
A1 J. Fiehler
A1 M. Chen
A1 M. Goyal
YR 2021
UL http://www.ajnr.org/content/early/2021/08/19/ajnr.A7253.abstract
AB 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