Region, specialty affect physicians’ decision-making for endovascular treatment of ischemic stroke
Decision-making criteria for treatment of patients with acute ischemic stroke with endovascular thrombectomy varied widely based on region and specialty, according to findings presented at the Society of NeuroInterventional Surgery Annual Meeting.
“Physicians of different specialties and practicing in different geographic regions make decisions based on different external variables,” presenter Mayank Goyal, MD, professor of radiology and clinical neurosciences and director of imaging and endovascular treatment at the University of Calgary in Alberta, Canada, said in a press release. “While it is promising to see acceptance of [endovascular treatment] as the standard of care for patients with acute ischemic stroke, it is clear that more work needs to be done to standardize decision-making for the benefit of all patients.”
The researchers surveyed 607 clinicians and interventionalists who treat patients with acute ischemic stroke from 38 countries. Each participant was given 10 acute ischemic stroke scenarios and asked how they would treat based on current local resources and based on an ideal resource scenario.
Among the cohort, 53.7% were neurologists, 28.5% were neurointerventional radiologists and 17.8% were other types of clinicians.
Participants cited the following factors as the most important when making decisions about whether to use endovascular thrombectomy:
- NIH Stroke Scale score, 34.9%;
- level of evidence, 30.2%;
- ASPECTS or ischemic core volume, 22.4%;
- patient age, 21.6%; and
- clinician experience with endovascular thrombectomy use, 19.3%.
Among the scenarios that met class IA evidence for use of endovascular thrombectomy, 86.8% of the time, participants said they would use endovascular thrombectomy, according to the researchers.
Among the scenarios that met class IIB evidence for use of endovascular thrombectomy, 66.3% of the time, participants said they would use endovascular thrombectomy, Goyal said.
Compared with ideal settings, current settings had a 4% practice gap in class IA scenarios and a 3% practice gap in class IIB scenarios, according to the researchers.
Under current local resources, decisions significantly varied by region and by specialty (P < .001 for both), but the differences disappeared under ideal resource scenarios. – by Erik Swain
Goyal M, et al. Late-breaking abstract presentations. Presented at: Society of NeuroInterventional Surgery Annual Meeting; July 22-26, 2019; Miami Beach, Fla.
Disclosures: The study was funded by an unrestricted research grant from Stryker to the University of Calgary. Goyal reports he consults for GE Healthcare, Medtronic, Mentice, Microvention and Stryker.