Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke

Autoři	CIMFLOVÁ Petra MCDONOUGH R. KAPPELHOF M. SINGH N. KASHANI N. OSPEL J. M. DEMCHUK A. M. MENON B. K. CHEN M. SAKAI N. FIEHLER J. GOYAL M.
Rok publikování	2021
Druh	Článek v odborném periodiku
Časopis / Zdroj	American Journal of Neuroradiology
Fakulta / Pracoviště MU	Lékařská fakulta
Citace
www	http://www.ajnr.org/content/42/12/2188
Doi	http://dx.doi.org/10.3174/ajnr.A7327
Klíčová slova	Endovascular Treatment; Secondary Medium-Vessel-Occlusion Stroke
Popis	BACKGROUND AND PURPOSE: Thrombus embolization during mechanical thrombectomy occurs in up to 9% of cases, making secondary medium vessel occlusions of particular interest to neurointerventionalists. We sought to gain insight into the current endovascular treatment approaches for secondary medium vessel occlusion stroke in an international case-based survey because there are currently no clear recommendations for endovascular treatment in these patients. MATERIALS AND METHODS: Survey participants were presented with 3 cases involving secondary medium vessel occlusions, each consisting of 3 case vignettes with changes in the patient?s neurologic status (improvement, no change, unable to assess). Multivariable logistic regression analyses clustered by the respondent?s identity were used to assess factors influencing the decision to treat. RESULTS: In total, 366 physicians (56 women, 308 men, 2 undisclosed) from 44 countries provided 3294 responses to 9 scenarios. Most (54.1%, 1782/3294) were in favor of endovascular treatment. Participants were more likely to treat occlusions in the anterior M2/3 (74.3%; risk ratio = 2.62; 95% CI, 2.27?3.03) or A3 (59.7%; risk ratio = 2.11; 95% CI, 1.83?2.42) segment compared with the M3/4 segment (28.3%; reference). Physicians were less likely to pursue endovascular treatment in patients who showed neurologic improvement than in patients with an unchanged neurologic deficit (49.9% versus 57.0% responses in favor of endovascular treatment, respectively; risk ratio = 0.88, 95% CI, 0.83?0.92). Interventionalists and more experienced physicians were more likely to treat secondary medium vessel occlusions. CONCLUSIONS: Physicians? willingness to treat secondary medium vessel occlusions endovascularly is limited and varies per occlusion location and change in neurologic status. More evidence on the safety and efficacy of endovascular treatment for secondary medium vessel occlusion stroke is needed.