Salwi Sanjana, Niec Jan A, Hassan Ameer E, Lindsell Christopher J, Khatri Pooja, Mocco J, Saver Jeffrey L, Mistry Eva A
School of Medicine, Vanderbilt University, Nashville, TN, United States.
Department of Neurology, University of Texas Rio Grande Valley, Harlingen, TX, United States.
Front Neurol. 2021 Oct 4;12:714594. doi: 10.3389/fneur.2021.714594. eCollection 2021.
It is unclear what factors clinicians consider when deciding about endovascular thrombectomy (EVT) in acute ischemic stroke patients with a pre-existing disability. We aimed to explore international practice patterns and preferences for EVT in patients with a pre-stroke disability, defined as a modified Rankin score (mRS) ≥ 2. Electronic survey link was sent to principal investigators of five major EVT trials and members of a professional interventional neurology society. Of the 81 survey-responding clinicians, 57% were neuro-interventionalists and 33% were non-interventional stroke clinicians. Overall, 64.2% would never or almost never consider EVT for a patient with pre-stroke mRS of 4-5, and 49.3% would always or almost always offer EVT for a patient with pre-stroke mRS 2-3. Perceived benefit of EVT (89%) and severity of baseline disability (83.5%) were identified as the most important clinician-level and patient-level factors that influence EVT decisions in these patients. In this survey of 80 respondents, we found that EVT practice for patients with pre-stroke disability across the world is heterogenous and depends upon patient characteristics. Individual clinician opinions substantially alter EVT decisions in pre-stroke disabled patients.
目前尚不清楚临床医生在决定对已有残疾的急性缺血性卒中患者进行血管内血栓切除术（EVT）时会考虑哪些因素。我们旨在探讨对卒中前残疾患者（定义为改良Rankin量表[mRS]评分≥2）进行EVT的国际实践模式和偏好。向五项主要EVT试验的主要研究者以及一个专业介入神经学会的成员发送了电子调查问卷链接。在81位回复调查问卷的临床医生中，57%为神经介入专家，33%为非介入性卒中临床医生。总体而言，64.2%的人永远不会或几乎不会考虑对卒中前mRS评分为4 - 5的患者进行EVT，而49.3%的人会始终或几乎始终为卒中前mRS评分为2 - 3的患者提供EVT。EVT的感知益处（89%）和基线残疾的严重程度（83.5%）被确定为影响这些患者EVT决策的最重要的临床医生层面和患者层面因素。在这项针对80名受访者的调查中，我们发现全球范围内对卒中前残疾患者进行EVT的实践存在差异，且取决于患者特征。个体临床医生的意见会显著改变对卒中前残疾患者的EVT决策。
