Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
J Neurointerv Surg. 2013 May;5 Suppl 1:i52-7. doi: 10.1136/neurintsurg-2012-010565. Epub 2012 Dec 12.
Intra-arterial therapy (IAT) is increasingly used to treat patients with acute stroke with large vessel occlusions. There are minimal data and guidelines for treatment indications and performance standards. We aimed to gain a better understanding of real-world practice patterns for IAT.
An internet-based survey was launched to address six specific areas of IAT: practice setting, operator background, operational protocols, quality/safety, decision-making and treatment strategies. The survey invitation was distributed to members of multiple neurointerventional societies.
Responses from 140 neurointerventionalists worldwide were analyzed. The median annual volume of IAT cases per institution was 40, and the median neurointerventional group size was three staff members. Independent predictors of case volume were presence of comprehensive stroke services and telestroke capability. The median minimum National Institutes of Health Stroke Scale score for treatment consideration was 8, although 60% of respondents reported no minimum score cut-off. There was no strict time window from symptom onset to treatment among 41% of respondents for anterior circulation strokes and among 56% for posterior circulation strokes, instead basing treatment decisions on clinical and imaging findings. Despite the emphasis on imaging-based selection, there was pronounced variability in the criteria used. Only 27% used one imaging approach exclusively. IAT following full- or partial-dose intravenous tissue plasminogen activator was performed by 89%. Mechanical devices were the predominant first-line therapy, but specific device usage depended on practice location. Approximately half preferred conscious sedation during IAT.
This survey illustrates significant variation among neurointerventionalists in the real-world use of IAT. Our findings highlight the need for evidence-based practice guidelines.
动脉内治疗（IAT）越来越多地用于治疗伴有大血管闭塞的急性脑卒中患者。目前针对治疗适应证和操作标准的数据和指南很少。我们旨在更好地了解 IAT 的实际操作模式。
我们开展了一项基于互联网的调查，以解决 IAT 的六个具体领域：实践环境、操作人员背景、操作方案、质量/安全、决策和治疗策略。调查邀请分发给多个神经介入学会的成员。
对来自全球 140 名神经介入医生的回复进行了分析。每个机构的 IAT 年病例数中位数为 40 例，神经介入组的中位数规模为 3 名工作人员。病例量的独立预测因素是综合卒中服务和远程卒中能力的存在。治疗考虑的中位数最低国立卫生研究院卒中量表（NIHSS）评分是 8 分，尽管 60%的受访者报告没有最低评分截止值。41%的前循环卒中患者和 56%的后循环卒中患者中，从发病到治疗没有严格的时间窗，而是根据临床和影像学发现来决定治疗。尽管强调基于影像学的选择，但使用的标准差异很大。只有 27%的人专门使用一种影像学方法。89%的人在全剂量或部分剂量静脉组织型纤溶酶原激活剂（tPA）治疗后进行 IAT。机械装置是主要的一线治疗方法，但具体装置的使用取决于实践地点。大约一半的人在 IAT 期间更喜欢清醒镇静。
这项调查表明，神经介入医生在实际应用 IAT 方面存在显著差异。我们的研究结果强调了制定基于证据的实践指南的必要性。
