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

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 and M. GOYAL. Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke. American Journal of Neuroradiology. Denville: American Society of Neuroradiology, 2021, vol. 42, No 12, p. 2188-2193. ISSN 0195-6108. Available from: https://dx.doi.org/10.3174/ajnr.A7327.

Basic information

Original name

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

Authors

CIMFLOVÁ, Petra (203 Czech Republic, belonging to the institution), R. MCDONOUGH, M. KAPPELHOF, N. SINGH, N. KASHANI, J. M. OSPEL, A. M. DEMCHUK, B. K. MENON, M. CHEN, N. SAKAI, J. FIEHLER and M. GOYAL (guarantor)

Edition

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

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Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30224 Radiology, nuclear medicine and medical imaging

Country of publisher

United States of America

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 4.966

RIV identification code

RIV/00216224:14110/21:00124155

Organization unit

Faculty of Medicine

DOI

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

UT WoS

000711963300001

Keywords in English

Endovascular Treatment; Secondary Medium-Vessel-Occlusion Stroke

Tags

14110119, rivok

Tags

International impact, Reviewed

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Abstract

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.