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  • Time of day and endovascular treatment decision in acute stroke with relative endovascular treatment indication: insights from UNMASK EVT international survey

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Ischemic Stroke
Original research
Time of day and endovascular treatment decision in acute stroke with relative endovascular treatment indication: insights from UNMASK EVT international survey
  1. Johanna Maria Ospel1,
  2. Nima Kashani2,
  3. Mayank Goyal3,
  4. Bijoy K Menon4,
  5. Bruce C V Campbell5,6,
  6. Urs Fischer7,
  7. Francis Turjman8,
  8. Peter Mitchell9,
  9. Shinichi Yoshimura10,
  10. Anna Podlasek11,
  11. Alejandro A Rabinstein12,
  12. Alexis T Wilson13,
  13. Byung Moon Kim14,
  14. Blaise W Baxter15,
  15. Mathew P Cherian16,
  16. Ji Hoe Heo17,
  17. Mona Foss18,
  18. Andrew M Demchuk19,
  19. Pillai N Sylaja20,
  20. Michael D Hill19,
  21. Gustavo Saposnik21,
  22. Mohammed A Almekhlafi22
  1. 1 Radiology, Universitatsspital Basel, Basel, Switzerland
  2. 2 Radiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  3. 3 Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
  4. 4 Calgary Stroke Program, University of Calgary, Calgary, Alberta, Canada
  5. 5 Medicine, University of Melbourne, Parkville, Victoria, Australia
  6. 6 Neurology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  7. 7 Department of Neurology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland
  8. 8 Department of Interventional Neuroradiology, Centre Hospitalier Universitaire de Lyon, Lyon, Rhône-Alpes, France
  9. 9 Radiology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  10. 10 Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan
  11. 11 Stroke Medicine, Southend University Hospital NHS Foundation Trust, Westcliff-on-Sea, Essex, UK
  12. 12 Neurology, Mayo Clinic, Rochester, Minnesota, USA
  13. 13 Cumming School of Medicine, Calgary, Alberta, Canada
  14. 14 Radiology, Yonsei University College of Medicine, Severance Hospita, Seoul, Republic of Korea
  15. 15 University of Tennessee, Knoxville, Tennessee, USA
  16. 16 Kovai Med Ctr, Coimbatore, Tamil Nadu, India
  17. 17 Seoul, The Democratic People’s Republic of Korea
  18. 18 Bootstrap Analytics, Calgary, Alberta, Canada
  19. 19 Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  20. 20 Sree Chitra Tirunal Institute for Medical Sciences and Technology, Thiruvananthapuram, Kerala, India
  21. 21 Division of Neurology, Department of Medicine, St Michael’s Hospital, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
  22. 22 Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  1. Correspondence to Dr Mohammed A Almekhlafi, Clinical Neurosciences, University of Calgary Cumming School of Medicine, Calgary T2N 4N1, Canada; mohammed.almekhlafi1{at}ucalgary.ca

Abstract

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.

  • intervention
  • standards
  • brain
  • stent

https://doi.org/10.1136/neurintsurg-2019-014976

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    Footnotes

    • 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.