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.

Basic information

Original name

Willingness to randomize primary medium vessel occlusions for endovascular treatment

Authors

SINGH, Nishita, Nima KASHANI, Manon KAPPELHOF, Petra CIMFLOVÁ (203 Czech Republic, belonging to the institution), Johanna OSPEL, Rosalie MCDONOUGH, Bijoy MENON, Michael CHEN, Jens FIEHLER, Noboyuki SAKAI and Mayank GOYAL (guarantor)

Edition

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

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30224 Radiology, nuclear medicine and medical imaging

Country of publisher

France

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

URL

Impact factor

Impact factor: 3.500

RIV identification code

RIV/00216224:14110/22:00128429

Organization unit

Faculty of Medicine

DOI

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

UT WoS

000775411600006

Keywords in English

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

Abstract

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 and Mayank GOYAL. Willingness to randomize primary medium vessel occlusions for endovascular treatment. JOURNAL OF NEURORADIOLOGY. ISSY: MASSON EDITEUR, 2022, vol. 49, No 2, p. 157-163. ISSN 0150-9861. Available from: 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 and Mayank GOYAL. Willingness to randomize primary medium vessel occlusions for endovascular treatment. \textit{JOURNAL OF NEURORADIOLOGY}. ISSY: MASSON EDITEUR, 2022, vol.~49, No~2, p.~157-163. ISSN~0150-9861. Available from: https://dx.doi.org/10.1016/j.neurad.2021.08.001.

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