Publication details
Patient-Relevant Deficits Dictate Endovascular Thrombectomy Decision-Making in Patients with Low NIHSS Scores with Medium-Vessel Occlusion Stroke
| Authors | |
|---|---|
| Year of publication | 2021 |
| Type | Article in Periodical |
| Magazine / Source | American Journal of Neuroradiology |
| MU Faculty or unit | |
| Citation | |
| Web | http://www.ajnr.org/content/42/10/1834 |
| Doi | http://dx.doi.org/10.3174/ajnr.A7253 |
| Keywords | Endovascular Thrombectomy; Low NIHSS Scores; Medium-Vessel Occlusion Stroke |
| Description | 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?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. |