Willingness to randomize primary medium vessel occlusions for
endovascular treatment

J 2022

Willingness to randomize primary medium vessel occlusions for endovascular treatment

SINGH, Nishita, Nima KASHANI, Manon KAPPELHOF, Petra CIMFLOVÁ, Johanna OSPEL et. al.

Základní údaje

Originální název

Willingness to randomize primary medium vessel occlusions for endovascular treatment

Autoři

SINGH, Nishita, Nima KASHANI, Manon KAPPELHOF, Petra CIMFLOVÁ (203 Česká republika, domácí), Johanna OSPEL, Rosalie MCDONOUGH, Bijoy MENON, Michael CHEN, Jens FIEHLER, Noboyuki SAKAI a Mayank GOYAL (garant)

Vydání

JOURNAL OF NEURORADIOLOGY, ISSY, MASSON EDITEUR, 2022, 0150-9861

Další údaje

Jazyk

angličtina

Typ výsledku

Článek v odborném periodiku

Obor

30224 Radiology, nuclear medicine and medical imaging

Stát vydavatele

Francie

Utajení

není předmětem státního či obchodního tajemství

Odkazy

URL

Impakt faktor

Impact factor: 3.500

Kód RIV

RIV/00216224:14110/22:00128429

Organizační jednotka

Lékařská fakulta

DOI

http://dx.doi.org/10.1016/j.neurad.2021.08.001

UT WoS

000775411600006

Klíčová slova anglicky

Acute ischemic stroke; Medium vessel occlusion; Distal occlusion; Endovascular therapy

Štítky

14110119, rivok

Příznaky

Mezinárodní význam, Recenzováno

Změněno: 31. 1. 2023 10:29, Mgr. Tereza Miškechová

Anotace

V originále

Background and purpose: Patients with acute ischemic stroke due to medium vessel occlusion (MeVO) make up a substantial part of the acute stroke population, though guidelines currently do not recommend endovascular treatment (EVT) for them. A growing body of evidence suggests that EVT is effective in MeVOs, including observational data but no randomized studies. We aimed to explore willingness of physicians worldwide to randomize MeVO stroke patients into a hypothetical trial comparing EVT in addition to best medical management versus best medical management only. Methods: In an international cross-sectional survey among stroke physicians, participants were presented with 4 cases of primary MeVOs (6 scenarios each). Each subsequent scenario changed one key patient characteristic compared to the previous one, and asked survey participants whether they would be willing to randomize the described patient. Overall, physician- and scenario-specific decision rates were calculated. Multivariable logistic regression with clustering by respondent was performed to assess factors influencing the decision to randomize. Results: Overall, 366 participants (56 women) from 44 countries provided 8784 answers to 24 MeVO case scenarios. The majority of responses (78.3%) were in favor of randomizing. Most physicians were willing to accept patients transferred for EVT from a primary center (82%) and the majority of these (76.5%) were willing to randomize these patients after transfer. Patient age > 65 years, A3 occlusion, small core volume, and patient intravenous alteplase eligibility significantly influenced the physician's decision to randomize (adjOR 1.24, 95%CI 1.13-1.36; adjOR 1.17, 95%CI 1.01-1.34; adjOR 0.98, 95%CI 0.97-0.99 and adjOR 1.38, 95%CI 1.21 -1.57, respectively). Conclusions: Most physicians in this survey were willing to randomize acute MeVO stroke patients irrespective of patient characteristics into a trial comparing EVT in addition to best medical management versus best medical management only, suggesting there is clinical equipoise.

Citovat

SINGH, Nishita, Nima KASHANI, Manon KAPPELHOF, Petra CIMFLOVÁ, Johanna OSPEL, Rosalie MCDONOUGH, Bijoy MENON, Michael CHEN, Jens FIEHLER, Noboyuki SAKAI a Mayank GOYAL. Willingness to randomize primary medium vessel occlusions for endovascular treatment. JOURNAL OF NEURORADIOLOGY. ISSY: MASSON EDITEUR, 2022, roč. 49, č. 2, s. 157-163. ISSN 0150-9861. Dostupné z: https://dx.doi.org/10.1016/j.neurad.2021.08.001.

@article{2251383,
   author = {Singh, Nishita and Kashani, Nima and Kappelhof, Manon and Cimflová, Petra and Ospel, Johanna and McDonough, Rosalie and Menon, Bijoy and Chen, Michael and Fiehler, Jens and Sakai, Noboyuki and Goyal, Mayank},
   article_location = {ISSY},
   article_number = {2},
   doi = {http://dx.doi.org/10.1016/j.neurad.2021.08.001},
   keywords = {Acute ischemic stroke; Medium vessel occlusion; Distal occlusion; Endovascular therapy},
   language = {eng},
   issn = {0150-9861},
   journal = {JOURNAL OF NEURORADIOLOGY},
   title = {Willingness to randomize primary medium vessel occlusions for endovascular treatment},
   url = {https://www.sciencedirect.com/science/article/pii/S0150986121001474?via%3Dihub},
   volume = {49},
   year = {2022}
}

TY  - JOUR
ID  - 2251383
AU  - Singh, Nishita - Kashani, Nima - Kappelhof, Manon - Cimflová, Petra - Ospel, Johanna - McDonough, Rosalie - Menon, Bijoy - Chen, Michael - Fiehler, Jens - Sakai, Noboyuki - Goyal, Mayank
PY  - 2022
TI  - Willingness to randomize primary medium vessel occlusions for endovascular treatment
JF  - JOURNAL OF NEURORADIOLOGY
VL  - 49
IS  - 2
SP  - 157-163
EP  - 157-163
PB  - MASSON EDITEUR
SN  - 01509861
KW  - Acute ischemic stroke
KW  - Medium vessel occlusion
KW  - Distal occlusion
KW  - Endovascular therapy
UR  - https://www.sciencedirect.com/science/article/pii/S0150986121001474?via%3Dihub
N2  - Background and purpose: Patients with acute ischemic stroke due to medium vessel occlusion (MeVO) make up a substantial part of the acute stroke population, though guidelines currently do not recommend endovascular treatment (EVT) for them. A growing body of evidence suggests that EVT is effective in MeVOs, including observational data but no randomized studies. We aimed to explore willingness of physicians worldwide to randomize MeVO stroke patients into a hypothetical trial comparing EVT in addition to best medical management versus best medical management only. Methods: In an international cross-sectional survey among stroke physicians, participants were presented with 4 cases of primary MeVOs (6 scenarios each). Each subsequent scenario changed one key patient characteristic compared to the previous one, and asked survey participants whether they would be willing to randomize the described patient. Overall, physician- and scenario-specific decision rates were calculated. Multivariable logistic regression with clustering by respondent was performed to assess factors influencing the decision to randomize. Results: Overall, 366 participants (56 women) from 44 countries provided 8784 answers to 24 MeVO case scenarios. The majority of responses (78.3%) were in favor of randomizing. Most physicians were willing to accept patients transferred for EVT from a primary center (82%) and the majority of these (76.5%) were willing to randomize these patients after transfer. Patient age > 65 years, A3 occlusion, small core volume, and patient intravenous alteplase eligibility significantly influenced the physician's decision to randomize (adjOR 1.24, 95%CI 1.13-1.36; adjOR 1.17, 95%CI 1.01-1.34; adjOR 0.98, 95%CI 0.97-0.99 and adjOR 1.38, 95%CI 1.21 -1.57, respectively). Conclusions: Most physicians in this survey were willing to randomize acute MeVO stroke patients irrespective of patient characteristics into a trial comparing EVT in addition to best medical management versus best medical management only, suggesting there is clinical equipoise.
ER  -

SINGH, Nishita, Nima KASHANI, Manon KAPPELHOF, Petra CIMFLOVÁ, Johanna OSPEL, Rosalie MCDONOUGH, Bijoy MENON, Michael CHEN, Jens FIEHLER, Noboyuki SAKAI a Mayank GOYAL. Willingness to randomize primary medium vessel occlusions for endovascular treatment. \textit{JOURNAL OF NEURORADIOLOGY}. ISSY: MASSON EDITEUR, 2022, roč.~49, č.~2, s.~157-163. ISSN~0150-9861. Dostupné z: https://dx.doi.org/10.1016/j.neurad.2021.08.001.

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