Johanna Maria Ospel1,2, Byungmoon Kim3, Ji-Hoe Heo4, Shinichi Yoshimura5, Nima Kashani6, Bijoy Menon1,6, Mohammed Almekhlafi1,6, Andrew Demchuk1,6, Michael Hill1,6, Gustavo Saposnik7, Mayank Goyal8,9. 1. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. 2. Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. 3. Department of Radiology, Severance Stroke Center, Yunsei University College of Medicine, Seoul, South Korea. 4. Department of Neurology, Yonsei University College of Medicine, Seoul, South Korea. 5. Department of Neurosurgery Hyogo College of Medicine 1-1 Mukogawa, Nishinomiya, Hyogo, Japan. 6. Department of Radiology, University of Calgary, Calgary, Canada. 7. Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada. 8. Department of Clinical Neurosciences, University of Calgary, Calgary, Canada. mgoyal@ucalgary.ca. 9. Department of Radiology, University of Calgary, Calgary, Canada. mgoyal@ucalgary.ca.
Abstract
PURPOSE: Many stroke patients with large vessel occlusion present with a low National Institutes of Health Stroke Scale (NIHSS). There is currently no level 1A recommendation for endovascular treatment (EVT) for this patient subgroup. From a physician's standpoint, the deficits might only be slight, but they are often devastating from a patient perspective. Furthermore, early neurologic deterioration is common. The purpose of this study was to explore endovascular treatment attitudes of physicians in acute ischemic stroke patients presenting with low admission NIHSS. METHODS: In an international cross-sectional survey among stroke physicians, participants were presented the scenario of a 76-year-old stroke patient with an admission NIHSS of 2. Survey participants were then asked how they would treat the patient (A) given their current local resources, and (B) under assumed ideal conditions, i.e., without external (monetary or infrastructural) constraints. Overall, country-specific and specialty-specific decision rates were calculated and clustered multivariable logistic regression performed to provide adjusted measures of effect size. RESULTS: Two hundred seventy-five participants (150 neurologists, 84 interventional neuroradiologists, 30 neurosurgeons, 11 affiliated to other specialties) from 33 countries provided their treatment approach to this case scenario. Most physicians favored an endovascular treatment approach, either combined with intravenous alteplase (55.3% under assumed ideal and 52.0% under current working conditions) or as single treatment (11.3% under assumed ideal and 8.4% under current conditions). CONCLUSION: Despite the limited evidence for endovascular therapy in acute stroke patients with low NIHSS, most physicians in this survey decided to proceed with endovascular therapy. A randomized controlled trial seems warranted.
PURPOSE: Many strokepatients with large vessel occlusion present with a low National Institutes of Health Stroke Scale (NIHSS). There is currently no level 1A recommendation for endovascular treatment (EVT) for this patient subgroup. From a physician's standpoint, the deficits might only be slight, but they are often devastating from a patient perspective. Furthermore, early neurologic deterioration is common. The purpose of this study was to explore endovascular treatment attitudes of physicians in acute ischemic strokepatients presenting with low admission NIHSS. METHODS: In an international cross-sectional survey among stroke physicians, participants were presented the scenario of a 76-year-old strokepatient with an admission NIHSS of 2. Survey participants were then asked how they would treat the patient (A) given their current local resources, and (B) under assumed ideal conditions, i.e., without external (monetary or infrastructural) constraints. Overall, country-specific and specialty-specific decision rates were calculated and clustered multivariable logistic regression performed to provide adjusted measures of effect size. RESULTS: Two hundred seventy-five participants (150 neurologists, 84 interventional neuroradiologists, 30 neurosurgeons, 11 affiliated to other specialties) from 33 countries provided their treatment approach to this case scenario. Most physicians favored an endovascular treatment approach, either combined with intravenous alteplase (55.3% under assumed ideal and 52.0% under current working conditions) or as single treatment (11.3% under assumed ideal and 8.4% under current conditions). CONCLUSION: Despite the limited evidence for endovascular therapy in acute strokepatients with low NIHSS, most physicians in this survey decided to proceed with endovascular therapy. A randomized controlled trial seems warranted.
Entities:
Keywords:
Acute ischemic stroke; Endovascular therapy; Guidelines; Minor stroke
Authors: R McDonough; P Cimflova; N Kashani; J M Ospel; M Kappelhof; N Singh; A Sehgal; N Sakai; J Fiehler; M Chen; M Goyal Journal: AJNR Am J Neuroradiol Date: 2021-08-19 Impact factor: 4.966
Authors: Stephan Waldeck; René Chapot; Christian von Falck; Matthias F Froelich; Marc Brockmann; Daniel Overhoff Journal: J Clin Med Date: 2022-01-28 Impact factor: 4.241