Background and purpose The decision to proceed with endovascular thrombectomy should ideally be made independent of inconvenience factors, such as daytime. We assessed the influence of patient presentation time on endovascular therapy decision making under current local resources and assumed ideal conditions in acute ischemic stroke with level 2B evidence for endovascular treatment.
Methods and materials In an international cross sectional survey, 607 stroke physicians from 38 countries were asked to give their treatment decisions to 10 out of 22 randomly assigned case scenarios. Eleven scenarios had level 2B evidence for endovascular treatment: 7 daytime scenarios (7:00 am–5:00 pm) and four night time cases (5:01 pm– 6:59 am). Participants provided their treatment approach assuming (A) there were no practice constraints and (B) under their current local resources. Endovascular treatment decisions in the 11 scenarios were analyzed according to presentation time with adjustment for patient and physician characteristics.
Results Participants selected endovascular therapy in 74.2% under assumed ideal conditions, and 70.7% under their current local resources of night time scenarios, and in 67.2% and 63.8% of daytime scenarios. Night time presentation did not increase the probability of a treatment decision against endovascular therapy under current local resources or assumed ideal conditions.
Conclusion Presentation time did not influence endovascular treatment decision making in stroke patients in this international survey.
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Contributors JMO: data analysis, interpretation of the data, and drafting and revision of the manuscript and figures. NK: data collection, interpretation of the data, drafting and revision of the figures, and critical revision of the manuscript. MG: data collection, fundraising, interpretation of the data, and drafting and critical revision of the manuscript. BKM, BCVC, UF, FT, PM, SY, AP, AAR, ATW, BMK, BWB, MPC, JHH, MF, AMD, PNS, and MDH: interpretation of the data, and critical revision of the manuscript. GS: data collection, interpretation of the data, and critical revision of the manuscript. MAA: data collection, drafting, interpretation of the data, and critical revision of the manuscript.
Funding This work was supported by Stryker through an unrestricted research grant to the University of Calgary. The company was not involved in the design, execution, analysis, and interpretation or reporting of the results.
Competing interests MG is a consultant for Medtronic, Stryker, Microvention, GE Healthcare, and Mentice. UF is a consultant for Medtronic, Stryker, andCSL Behring, and co-PI of the SWIFT DIRECT trial (Medtronic). FT works as a consultant for Balt and Stryker. BWB works as a consultant for Penumbra, Medtronic, Stryker, 880 Medical and Metactive, owns stock options (Penumbra,Viz.ai), and has ownership interests on Route 92 and Marblehead. GS issupported by the Heart and Stroke Foundation of Canada Career Award.
Provenance and peer review Not commissioned; externally peer reviewed.
Correction notice Since this article was first published online, the author Pillai Sylaja has had their middle initial N added to their name.
Patient consent for publication Not required.