From the Departments of Clinical Neurosciences (P.C., N.S., A.M.D., B.K.M., M.G.).
Department of Medical Imaging (P.C.), St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic.
AJNR Am J Neuroradiol. 2021 Dec;42(12):2188-2193. doi: 10.3174/ajnr.A7327. Epub 2021 Oct 28.
Thrombus embolization during mechanical thrombectomy occurs in up to 9% of cases, making secondary medium vessel occlusions of particular interest to neurointerventionalists. We sought to gain insight into the current endovascular treatment approaches for secondary medium vessel occlusion stroke in an international case-based survey because there are currently no clear recommendations for endovascular treatment in these patients.
Survey participants were presented with 3 cases involving secondary medium vessel occlusions, each consisting of 3 case vignettes with changes in the patient's neurologic status (improvement, no change, unable to assess). Multivariable logistic regression analyses clustered by the respondent's identity were used to assess factors influencing the decision to treat.
In total, 366 physicians (56 women, 308 men, 2 undisclosed) from 44 countries provided 3294 responses to 9 scenarios. Most (54.1%, 1782/3294) were in favor of endovascular treatment. Participants were more likely to treat occlusions in the anterior M2/3 (74.3%; risk ratio = 2.62; 95% CI, 2.27-3.03) or A3 (59.7%; risk ratio = 2.11; 95% CI, 1.83-2.42) segment compared with the M3/4 segment (28.3%; reference). Physicians were less likely to pursue endovascular treatment in patients who showed neurologic improvement than in patients with an unchanged neurologic deficit (49.9% versus 57.0% responses in favor of endovascular treatment, respectively; risk ratio = 0.88, 95% CI, 0.83-0.92). Interventionalists and more experienced physicians were more likely to treat secondary medium vessel occlusions.
Physicians' willingness to treat secondary medium vessel occlusions endovascularly is limited and varies per occlusion location and change in neurologic status. More evidence on the safety and efficacy of endovascular treatment for secondary medium vessel occlusion stroke is needed.
机械取栓术中血栓栓塞的发生率高达 9%，这使得神经介入医生特别关注继发的中等血管闭塞。我们试图通过一项国际基于病例的调查，深入了解目前治疗继发中等血管闭塞性卒中的血管内治疗方法，因为目前针对这些患者的血管内治疗尚无明确建议。
向调查参与者展示了 3 例涉及继发中等血管闭塞的病例，每个病例均由 3 个病例描述组成，患者的神经状态发生变化（改善、无变化、无法评估）。使用按应答者身份聚类的多变量逻辑回归分析来评估影响治疗决策的因素。
共有来自 44 个国家的 366 名医生（56 名女性，308 名男性，2 名未公开）对 9 种情况做出了 3294 次应答。大多数（54.1%，1782/3294）赞成血管内治疗。与 M3/4 节段（28.3%，参考）相比，参与者更倾向于治疗前 M2/3（74.3%；风险比=2.62；95%置信区间，2.27-3.03）或 A3 段（59.7%；风险比=2.11；95%置信区间，1.83-2.42）的闭塞。与神经功能无变化的患者相比，表现出神经功能改善的患者接受血管内治疗的可能性较小（分别有 49.9%和 57.0%的应答者赞成血管内治疗；风险比=0.88，95%置信区间，0.83-0.92）。介入医生和经验更丰富的医生更倾向于治疗继发中等血管闭塞。
医生对继发中等血管闭塞进行血管内治疗的意愿有限，且根据闭塞部位和神经状态的变化而有所不同。需要更多关于血管内治疗继发中等血管闭塞性卒中的安全性和有效性的证据。
