Department of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Division of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, University of Basel, Basel, Switzerland.
Neuroradiology. 2020 Jun;62(6):715-721. doi: 10.1007/s00234-020-02371-6. Epub 2020 Feb 15.
Many stroke patients with large vessel occlusion present with a low National Institutes of Health Stroke Scale (NIHSS). There is currently no level 1A recommendation for endovascular treatment (EVT) for this patient subgroup. From a physician's standpoint, the deficits might only be slight, but they are often devastating from a patient perspective. Furthermore, early neurologic deterioration is common. The purpose of this study was to explore endovascular treatment attitudes of physicians in acute ischemic stroke patients presenting with low admission NIHSS.
In an international cross-sectional survey among stroke physicians, participants were presented the scenario of a 76-year-old stroke patient with an admission NIHSS of 2. Survey participants were then asked how they would treat the patient (A) given their current local resources, and (B) under assumed ideal conditions, i.e., without external (monetary or infrastructural) constraints. Overall, country-specific and specialty-specific decision rates were calculated and clustered multivariable logistic regression performed to provide adjusted measures of effect size.
Two hundred seventy-five participants (150 neurologists, 84 interventional neuroradiologists, 30 neurosurgeons, 11 affiliated to other specialties) from 33 countries provided their treatment approach to this case scenario. Most physicians favored an endovascular treatment approach, either combined with intravenous alteplase (55.3% under assumed ideal and 52.0% under current working conditions) or as single treatment (11.3% under assumed ideal and 8.4% under current conditions).
Despite the limited evidence for endovascular therapy in acute stroke patients with low NIHSS, most physicians in this survey decided to proceed with endovascular therapy. A randomized controlled trial seems warranted.
许多大血管闭塞的脑卒中患者 NIHSS 评分较低。目前，对于这一亚组患者，尚无血管内治疗（EVT）的 1A 级推荐。从医生的角度来看，这些缺陷可能只是轻微的，但从患者的角度来看，它们往往是毁灭性的。此外，早期神经功能恶化很常见。本研究旨在探讨 NIHSS 评分较低的急性缺血性脑卒中患者血管内治疗态度的医生。
在一项针对脑卒中医生的国际横断面调查中，向参与者呈现了一位 76 岁脑卒中患者的入院 NIHSS 评分为 2 分的情况。然后，调查参与者被问及在当前当地资源的情况下（A）以及在假设的理想条件下（即没有外部（货币或基础设施）限制），他们将如何治疗该患者。总体而言，计算了特定国家和特定专业的决策率，并进行了多变量逻辑回归分析，以提供调整后的效应大小衡量标准。
来自 33 个国家的 275 名参与者（150 名神经科医生、84 名介入神经放射科医生、30 名神经外科医生、11 名其他专业）提供了他们对这种病例情况的治疗方法。大多数医生倾向于血管内治疗方法，要么联合静脉内使用阿替普酶（假设理想条件下为 55.3%，当前工作条件下为 52.0%），要么作为单一治疗（假设理想条件下为 11.3%，当前条件下为 8.4%）。
尽管 NIHSS 评分较低的急性脑卒中患者血管内治疗的证据有限，但本调查中的大多数医生决定采用血管内治疗。似乎需要进行一项随机对照试验。
