Perceived Limits of Endovascular Treatment for Secondary
Medium-Vessel-Occlusion Stroke

J 2021

Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke

CIMFLOVÁ, Petra, R. MCDONOUGH, M. KAPPELHOF, N. SINGH, N. KASHANI et. al.

Základní údaje

Originální název

Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke

Autoři

CIMFLOVÁ, Petra (203 Česká republika, domácí), R. MCDONOUGH, M. KAPPELHOF, N. SINGH, N. KASHANI, J. M. OSPEL, A. M. DEMCHUK, B. K. MENON, M. CHEN, N. SAKAI, J. FIEHLER a M. GOYAL (garant)

Vydání

American Journal of Neuroradiology, Denville, American Society of Neuroradiology, 2021, 0195-6108

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30224 Radiology, nuclear medicine and medical imaging

Stát vydavatele

Spojené státy

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 4.966

Kód RIV

RIV/00216224:14110/21:00124155

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.3174/ajnr.A7327

UT WoS

000711963300001

Klíčová slova anglicky

Endovascular Treatment; Secondary Medium-Vessel-Occlusion Stroke

Štítky

14110119, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 15. 2. 2022 10:03, Mgr. Tereza Miškechová

Anotace

V originále

BACKGROUND AND PURPOSE: Thrombus embolization during mechanical thrombectomy occurs in up to 9% of cases, making secondary medium vessel occlusions of particular interest to neurointerventionalists. We sought to gain insight into the current endovascular treatment approaches for secondary medium vessel occlusion stroke in an international case-based survey because there are currently no clear recommendations for endovascular treatment in these patients. MATERIALS AND METHODS: Survey participants were presented with 3 cases involving secondary medium vessel occlusions, each consisting of 3 case vignettes with changes in the patient?s neurologic status (improvement, no change, unable to assess). Multivariable logistic regression analyses clustered by the respondent?s identity were used to assess factors influencing the decision to treat. RESULTS: In total, 366 physicians (56 women, 308 men, 2 undisclosed) from 44 countries provided 3294 responses to 9 scenarios. Most (54.1%, 1782/3294) were in favor of endovascular treatment. Participants were more likely to treat occlusions in the anterior M2/3 (74.3%; risk ratio = 2.62; 95% CI, 2.27?3.03) or A3 (59.7%; risk ratio = 2.11; 95% CI, 1.83?2.42) segment compared with the M3/4 segment (28.3%; reference). Physicians were less likely to pursue endovascular treatment in patients who showed neurologic improvement than in patients with an unchanged neurologic deficit (49.9% versus 57.0% responses in favor of endovascular treatment, respectively; risk ratio = 0.88, 95% CI, 0.83?0.92). Interventionalists and more experienced physicians were more likely to treat secondary medium vessel occlusions. CONCLUSIONS: Physicians? willingness to treat secondary medium vessel occlusions endovascularly is limited and varies per occlusion location and change in neurologic status. More evidence on the safety and efficacy of endovascular treatment for secondary medium vessel occlusion stroke is needed.

Citovat

CIMFLOVÁ, Petra, R. MCDONOUGH, M. KAPPELHOF, N. SINGH, N. KASHANI, J. M. OSPEL, A. M. DEMCHUK, B. K. MENON, M. CHEN, N. SAKAI, J. FIEHLER a M. GOYAL. Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke. American Journal of Neuroradiology. Denville: American Society of Neuroradiology, 2021, roč. 42, č. 12, s. 2188-2193. ISSN 0195-6108. Dostupné z: https://dx.doi.org/10.3174/ajnr.A7327.

@article{1834309,
   author = {Cimflová, Petra and McDonough, R. and Kappelhof, M. and Singh, N. and Kashani, N. and Ospel, J. M. and Demchuk, A. M. and Menon, B. K. and Chen, M. and Sakai, N. and Fiehler, J. and Goyal, M.},
   article_location = {Denville},
   article_number = {12},
   doi = {http://dx.doi.org/10.3174/ajnr.A7327},
   keywords = {Endovascular Treatment; Secondary Medium-Vessel-Occlusion Stroke},
   language = {eng},
   issn = {0195-6108},
   journal = {American Journal of Neuroradiology},
   title = {Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke},
   url = {http://www.ajnr.org/content/42/12/2188},
   volume = {42},
   year = {2021}
}

TY  - JOUR
ID  - 1834309
AU  - Cimflová, Petra - McDonough, R. - Kappelhof, M. - Singh, N. - Kashani, N. - Ospel, J. M. - Demchuk, A. M. - Menon, B. K. - Chen, M. - Sakai, N. - Fiehler, J. - Goyal, M.
PY  - 2021
TI  - Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke
JF  - American Journal of Neuroradiology
VL  - 42
IS  - 12
SP  - 2188-2193
EP  - 2188-2193
PB  - American Society of Neuroradiology
SN  - 01956108
KW  - Endovascular Treatment
KW  - Secondary Medium-Vessel-Occlusion Stroke
UR  - http://www.ajnr.org/content/42/12/2188
N2  - BACKGROUND AND PURPOSE: Thrombus embolization during mechanical thrombectomy occurs in up to 9% of cases, making secondary medium vessel occlusions of particular interest to neurointerventionalists. We sought to gain insight into the current endovascular treatment approaches for secondary medium vessel occlusion stroke in an international case-based survey because there are currently no clear recommendations for endovascular treatment in these patients. MATERIALS AND METHODS: Survey participants were presented with 3 cases involving secondary medium vessel occlusions, each consisting of 3 case vignettes with changes in the patient?s neurologic status (improvement, no change, unable to assess). Multivariable logistic regression analyses clustered by the respondent?s identity were used to assess factors influencing the decision to treat. RESULTS: In total, 366 physicians (56 women, 308 men, 2 undisclosed) from 44 countries provided 3294 responses to 9 scenarios. Most (54.1%, 1782/3294) were in favor of endovascular treatment. Participants were more likely to treat occlusions in the anterior M2/3 (74.3%; risk ratio = 2.62; 95% CI, 2.27?3.03) or A3 (59.7%; risk ratio = 2.11; 95% CI, 1.83?2.42) segment compared with the M3/4 segment (28.3%; reference). Physicians were less likely to pursue endovascular treatment in patients who showed neurologic improvement than in patients with an unchanged neurologic deficit (49.9% versus 57.0% responses in favor of endovascular treatment, respectively; risk ratio = 0.88, 95% CI, 0.83?0.92). Interventionalists and more experienced physicians were more likely to treat secondary medium vessel occlusions. CONCLUSIONS: Physicians? willingness to treat secondary medium vessel occlusions endovascularly is limited and varies per occlusion location and change in neurologic status. More evidence on the safety and efficacy of endovascular treatment for secondary medium vessel occlusion stroke is needed.
ER  -

CIMFLOVÁ, Petra, R. MCDONOUGH, M. KAPPELHOF, N. SINGH, N. KASHANI, J. M. OSPEL, A. M. DEMCHUK, B. K. MENON, M. CHEN, N. SAKAI, J. FIEHLER a M. GOYAL. Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke. \textit{American Journal of Neuroradiology}. Denville: American Society of Neuroradiology, 2021, roč.~42, č.~12, s.~2188-2193. ISSN~0195-6108. Dostupné z: https://dx.doi.org/10.3174/ajnr.A7327.

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