Willingness to randomize primary medium vessel occlusions for endovascular treatment
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Willingness to randomize primary medium vessel occlusions for endovascular treatment. / Singh, Nishita; Kashani, Nima; Kappelhof, Manon; Cimflova, Petra; Ospel, Johanna; McDonough, Rosalie; Menon, Bijoy; Chen, Michael; Fiehler, Jens; Sakai, Noboyuki; Goyal, Mayank.
In: J NEURORADIOLOGY, Vol. 49, No. 2, 03.2022, p. 157-163.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Willingness to randomize primary medium vessel occlusions for endovascular treatment
AU - Singh, Nishita
AU - Kashani, Nima
AU - Kappelhof, Manon
AU - Cimflova, Petra
AU - Ospel, Johanna
AU - McDonough, Rosalie
AU - Menon, Bijoy
AU - Chen, Michael
AU - Fiehler, Jens
AU - Sakai, Noboyuki
AU - Goyal, Mayank
N1 - Copyright © 2021 Elsevier Masson SAS. All rights reserved.
PY - 2022/3
Y1 - 2022/3
N2 - BACKGROUND AND PURPOSE: Patients with acute ischemic stroke due to medium vessel occlusion (MeVO) make up a substantial part of the acute stroke population, though guidelines currently do not recommend endovascular treatment (EVT) for them. A growing body of evidence suggests that EVT is effective in MeVOs, including observational data but no randomized studies. We aimed to explore willingness of physicians worldwide to randomize MeVO stroke patients into a hypothetical trial comparing EVT in addition to best medical management versus best medical management only.METHODS: In an international cross-sectional survey among stroke physicians, participants were presented with 4 cases of primary MeVOs (6 scenarios each). Each subsequent scenario changed one key patient characteristic compared to the previous one, and asked survey participants whether they would be willing to randomize the described patient. Overall, physician- and scenario-specific decision rates were calculated. Multivariable logistic regression with clustering by respondent was performed to assess factors influencing the decision to randomize.RESULTS: Overall, 366 participants (56 women) from 44 countries provided 8784 answers to 24 MeVO case scenarios. The majority of responses (78.3%) were in favor of randomizing. Most physicians were willing to accept patients transferred for EVT from a primary center (82%) and the majority of these (76.5%) were willing to randomize these patients after transfer. Patient age > 65 years, A3 occlusion, small core volume, and patient intravenous alteplase eligibility significantly influenced the physician's decision to randomize (adjOR 1.24, 95%CI 1.13-1.36; adjOR 1.17, 95%CI 1.01-1.34; adjOR 0.98, 95%CI 0.97-0.99 and adjOR 1.38, 95%CI 1.21-1.57, respectively).CONCLUSIONS: Most physicians in this survey were willing to randomize acute MeVO stroke patients irrespective of patient characteristics into a trial comparing EVT in addition to best medical management versus best medical management only, suggesting there is clinical equipoise.
AB - BACKGROUND AND PURPOSE: Patients with acute ischemic stroke due to medium vessel occlusion (MeVO) make up a substantial part of the acute stroke population, though guidelines currently do not recommend endovascular treatment (EVT) for them. A growing body of evidence suggests that EVT is effective in MeVOs, including observational data but no randomized studies. We aimed to explore willingness of physicians worldwide to randomize MeVO stroke patients into a hypothetical trial comparing EVT in addition to best medical management versus best medical management only.METHODS: In an international cross-sectional survey among stroke physicians, participants were presented with 4 cases of primary MeVOs (6 scenarios each). Each subsequent scenario changed one key patient characteristic compared to the previous one, and asked survey participants whether they would be willing to randomize the described patient. Overall, physician- and scenario-specific decision rates were calculated. Multivariable logistic regression with clustering by respondent was performed to assess factors influencing the decision to randomize.RESULTS: Overall, 366 participants (56 women) from 44 countries provided 8784 answers to 24 MeVO case scenarios. The majority of responses (78.3%) were in favor of randomizing. Most physicians were willing to accept patients transferred for EVT from a primary center (82%) and the majority of these (76.5%) were willing to randomize these patients after transfer. Patient age > 65 years, A3 occlusion, small core volume, and patient intravenous alteplase eligibility significantly influenced the physician's decision to randomize (adjOR 1.24, 95%CI 1.13-1.36; adjOR 1.17, 95%CI 1.01-1.34; adjOR 0.98, 95%CI 0.97-0.99 and adjOR 1.38, 95%CI 1.21-1.57, respectively).CONCLUSIONS: Most physicians in this survey were willing to randomize acute MeVO stroke patients irrespective of patient characteristics into a trial comparing EVT in addition to best medical management versus best medical management only, suggesting there is clinical equipoise.
U2 - 10.1016/j.neurad.2021.08.001
DO - 10.1016/j.neurad.2021.08.001
M3 - SCORING: Journal article
C2 - 34543664
VL - 49
SP - 157
EP - 163
JO - J NEURORADIOLOGY
JF - J NEURORADIOLOGY
SN - 0150-9861
IS - 2
ER -