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Ischemic stroke
Original research
Factors influencing thrombectomy decision making for primary medium vessel occlusion stroke
  1. Petra Cimflova1,2,
  2. Manon Kappelhof3,4,
  3. Nishita Singh1,
  4. Nima Kashani4,5,
  5. Johanna Maria Ospel6,
  6. Rosalie McDonough4,7,
  7. Andrew M Demchuk1,8,
  8. Bijoy K Menon1,
  9. Nobuyuki Sakai9,
  10. Michael Chen10,
  11. Jens Fiehler7,
  12. Mayank Goyal4
  1. 1 Clinical Neurosciences, University of Calgary, Calgary, Alberta, Canada
  2. 2 Medical Imaging, Fakultní nemocnice u sv Anny v Brně, Brno, Czech Republic
  3. 3 Radiology and Nuclear Medicine, University of Amsterdam, Amsterdam, The Netherlands
  4. 4 Diagnostic Imaging, University of Calgary, Calgary, Alberta, Canada
  5. 5 Neuroradiology, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  6. 6 Radiology and Nuclear Medicine, Universitatsspital Basel, Basel, Switzerland
  7. 7 Department of Diagnostic and Interventional Neuroradiology, University Hospital Hamburg Eppendorf, Hamburg, Germany
  8. 8 Hotchkiss Brain Institute, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  9. 9 Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
  10. 10 Neurological Sciences, Rush University Medical Center, Chicago, Illinois, USA
  1. Correspondence to Dr Mayank Goyal, Diagnostic Imaging, University of Calgary, Calgary, AB T2N 1N4, Canada; mgoyal2412{at}gmail.com

Abstract

Background We aimed to explore the preference of stroke physicians to treat patients with primary medium vessel occlusion (MeVO) stroke with immediate endovascular treatment (EVT) in an international cross-sectional survey, as there is no clear guideline recommendation for EVT in these patients.

Methods In the survey MeVO-Finding Rationales and Objectifying New Targets for IntervEntional Revascularization in Stroke (MeVO-FRONTIERS), participants were shown four cases of primary MeVOs (six scenarios per case) and asked whether they would treat those patients with EVT. Multivariable logistic regression with clustering by respondent was performed to assess factors influencing the decision to treat. Dominance analysis was performed to assess the influence of factors within the scenarios on decision making.

Results Overall, 366 participants (56 women; 15%) from 44 countries provided 8784 answers to 24 scenarios. Most physicians (59.2%) would treat patients immediately with EVT. Younger patient age (incidence rate ratio (IRR) 1.24, 99% CI 1.19 to 1.30), higher National Institutes of Health Stroke Scale (NIHSS) score (IRR 1.69, 99% CI 1.57 to 1.82), and small core volume (IRR 1.35, 99% CI 1.24 to 1.46) were positively associated with the decision to treat with EVT. Interventionalists (IRR 1.26, 99% CI 1.01 to 1.56) were more likely to treat patients with MeVO immediately with EVT. In the dominance analysis, factors influencing the decision in favor of EVT were (in order of importance): baseline NIHSS, core volume, alteplase use, patients’ age, and occlusion site.

Conclusions Most physicians in this survey were interventionalists and would treat patients with MeVO stroke immediately with EVT. This finding supports the need for robust clinical evidence.

  • stroke
  • thrombectomy
  • intervention

Data availability statement

Data are available upon reasonable request. Data used in the current study are available from the author upon reasonable request.

https://doi.org/10.1136/neurintsurg-2021-017472

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    Data availability statement

    Data are available upon reasonable request. Data used in the current study are available from the author upon reasonable request.

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    Footnotes

    • Twitter @nimakashani, @johanna_ospel, @dr_mchen, @Fie0815

    • Contributors All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by PC, MK, NK, NS, JMO, and RM. The first draft of the manuscript was written by PC, MK, and RM. All authors commented on previous versions of the manuscript and read and approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Map disclaimer The depiction of boundaries on the map(s) in this article does not imply the expression of any opinion whatsoever on the part of BMJ (or any member of its group) concerning the legal status of any country, territory, jurisdiction or area or of its authorities. The map(s) are provided without any warranty of any kind, either express or implied.

    • Competing interests AMD reports editorial board membership at International Journal of Stroke (Editor). BKM reports editorial board membership at Stroke (Assistant Editor). MC reports personal fees from Stryker, personal fees from Microvention, Medtronic, Genentech, Cerenovus, Penumbra outside the submitted work; and editorial board membership at Journal of NeuroInterventional Surgery (Commissioning Editor). JF reports grants and personal fees from Stryker, Acandis, Microvention, Medtronic, personal fees from Codman, Ceronovus, Penumbra, Phenox, other (stock ownership) from Tegus outside the submitted work; and editorial board memberships at Journal of NeuroInterventional Surgery (Associate Editor) and Clinical Neuroradiology (Editor); and Executive functions with University Medical Center Hamburg-Eppendorf, Eppdata GmbH. MG reports personal fees from Stryker, personal fees from Mentice, Microvention, and Medtronic outside the submitted work; and editorial board membership at Stroke (Consulting Editor). In addition, NG has a patent for Systems of acute stroke diagnosis issued and licensed. PC, MK, NS, NK, JMO, RM, NS have nothing to disclose.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.