Patient-Relevant Deficits Dictate Endovascular Thrombectomy Decision-Making in Patients with Low NIHSS Scores with Medium-Vessel Occlusion Stroke

Autoři	MCDONOUGH R. CIMFLOVÁ Petra KASHANI N. OSPEL J. M. KAPPELHOF M. SINGH N. SEHGAL A. SAKAI N. FIEHLER J. CHEN M. 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/42/10/1834
Doi	http://dx.doi.org/10.3174/ajnr.A7253
Klíčová slova	Endovascular Thrombectomy; Low NIHSS Scores; Medium-Vessel Occlusion Stroke
Popis	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.