R McDonough1,2, P Cimflova3,4, N Kashani2, J M Ospel5, M Kappelhof2,6, N Singh4, A Sehgal2, N Sakai7, J Fiehler1, M Chen8, M Goyal9,3. 1. From the Department of Diagnostic and Interventional Neuroradiology (R.M., J.F.), University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 2. Department of Diagnostic Imaging (R.M., N.K., M.K., A.S., M.G.), Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada. 3. Department of Medical Imaging (P.C., M.G.), St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic. 4. Department of Clinical Neurosciences (P.C., N.S.), Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada. 5. Division of Neuroradiology (J.M.O.), Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland. 6. Department of Radiology and Nuclear Medicine (M.K.), University of Amsterdam, Amsterdam, the Netherlands. 7. Department of Neurosurgery (N.S.), Kobe City Medical Centre General Hospital, Kobe, Japan. 8. Department of Neurological Sciences (M.C.), Rush University Medical Center, Chicago, Illinois. 9. Department of Diagnostic Imaging (R.M., N.K., M.K., A.S., M.G.), Foothills Medical Center, University of Calgary, Calgary, Alberta, Canada mgoyal@ucalgary.ca.
Abstract
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.
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.
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Authors: Fabricio O Lima; Karen L Furie; Gisele S Silva; Michael H Lev; Erica C S Camargo; Aneesh B Singhal; Gordon J Harris; Elkan F Halpern; Walter J Koroshetz; Wade S Smith; Raul G Nogueira Journal: JAMA Neurol Date: 2014-02 Impact factor: 18.302
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