RT Journal Article
SR Electronic
T1 Mechanical thrombectomy decision making and prognostication: Stroke treatment Assessments prior to Thrombectomy In Neurointervention (SATIN) study
JF Journal of NeuroInterventional Surgery
JO J NeuroIntervent Surg
FD BMJ Publishing Group Ltd.
SP jnis-2022-019741
DO 10.1136/jnis-2022-019741
A1 Kyle M Fargen
A1 Carol Kittel
A1 Brian P Curry
A1 Connor W Hile
A1 Stacey Q Wolfe
A1 Patrick Brown
A1 Maxim Mokin
A1 Ansaar T Rai
A1 Michael Chen
A1 Robert M Starke
A1 Felipe C Albuquerque
A1 Sameer A Ansari
A1 Peter Kan
A1 Alejandro M Spiotta
A1 Guilherme Dabus
A1 Thabele M Leslie-Mazwi
A1 Joshua A Hirsch
A1 ,
YR 2023
UL http://jnis.bmj.com/content/early/2023/01/05/jnis-2022-019741.abstract
AB Background Mechanical thrombectomy (MT) is the standard-of-care treatment for stroke patients with emergent large vessel occlusions. Despite this, little is known about physician decision making regarding MT and prognostic accuracy.Methods A prospective multicenter cohort study of patients undergoing MT was performed at 11 comprehensive stroke centers. The attending neurointerventionalist completed a preprocedure survey prior to arterial access and identified key decision factors and the most likely radiographic and clinical outcome at 90 days. Post hoc review was subsequently performed to document hospital course and outcome.Results 299 patients were enrolled. Good clinical outcome (modified Rankin Scale (mRS) score of 0–2) was obtained in 38% of patients. The most frequently identified factors influencing the decision to proceed with thrombectomy were site of occlusion (81%), National Institutes of Health Stroke Scale score (74%), and perfusion imaging mismatch (43%). Premorbid mRS score determination in the hyperacute setting accurately matched retrospectively collected data from the hospital admission in only 140 patients (46.8%). Physicians correctly predicted the patient’s 90 day mRS tertile (0–2, 3–4, or 5–6) and final modified Thrombolysis in Ischemic Cerebral Infarction score preprocedure in only 44.2% and 44.3% of patients, respectively. Clinicians tended to overestimate the influence of occlusion site and perfusion imaging on outcomes, while underestimating the importance of pre-morbid mRS.Conclusions This is the first prospective study to evaluate neurointerventionalists’ ability to accurately predict clinical outcome after MT. Overall, neurointerventionalists performed poorly in prognosticating patient 90 day outcomes, raising ethical questions regarding whether MT should be withheld in patients with emergent large vessel occlusions thought to have a poor prognosis.All data relevant to the study are included in the article or uploaded as supplementary information.