Specialist perspectives on the imaging selection of large vessel occlusion in the late window

Piers Klein, Xiaochuan Huo, Yimin Chen, Mohamad Abdalkader, Zhongming Qiu, Simon Nagel, Jean Raymond, Liping Liu, James E. Siegler, Daniel Strbian, Thalia S. Field, Shadi Yaghi, Muhammad M. Qureshi, Jelle Demeestere, Volker Puetz, Anne Berberich, Patrik Michel, Urs Fischer, Johannes Kaesmacher, Hiroshi YamagamiFana Alemseged, Georgios Tsivgoulis, Wouter J. Schonewille, Wei Hu, Xinfeng Liu, Chuanhui Li, Xunming Ji, Brian Drumm, Soma Banerjee, Simona Sacco, Else C. Sandset, Espen Saxhaug Kristoffersen, Peter Slade, Robert Mikulik, Michele Romoli, Francesco Diana, Kailash Krishnan, Permesh Dhillon, Jin Soo Lee, Ekkehard Kasper, Hormuzdiyar Dasenbrock, Mai Duy Ton, Rytis Masiliūnas, Anita Ante Arsovska, João Pedro Marto, Adam A. Dmytriw, Robert W. Regenhardt, Gisele Sampaio Silva, Timo Siepmann, Dapeng Sun, Hongfei Sang, Jose Danilo Diestro, Pengfei Yang, Mahmoud H. Mohammaden, Fengli Li, Hesham E. Masoud, Alice Ma, Raynald, Aravind Ganesh, Jianmin Liu, Lukas Meyer, Diederik W.J. Dippel, Götz Thomalla, Mark Parsons, Adnan I. Qureshi, Mayank Goyal, Albert J. Yoo, Bertrand Lapergue, Osama O. Zaidat, Hui Sheng Chen, Bruce C.V. Campbell, Tudor G. Jovin, Raul G. Nogueira, Zhongrong Miao, Gustavo Saposnik, Thanh N. Nguyen*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)

Abstract

Background: The proper imaging modality for use in the selection of patients for endovascular thrombectomy (EVT) presenting in the late window remains controversial, despite current guidelines advocating the use of advanced imaging in this population. We sought to understand if clinicians with different specialty training differ in their approach to patient selection for EVT in the late time window. Methods: We conducted an international survey of stroke and neurointerventional clinicians between January and May 2022 with questions focusing on imaging and treatment decisions of large vessel occlusion (LVO) patients presenting in the late window. Interventional neurologists, interventional neuroradiologists, and endovascular neurosurgeons were defined as interventionists whereas all other specialties were defined as non-interventionists. The non-interventionist group was defined by all other specialties of the respondents: stroke neurologist, neuroradiologist, emergency medicine physician, trainee (fellows and residents) and others. Results: Of 3000 invited to participate, 1506 (1027 non-interventionists, 478 interventionists, 1 declined to specify) physicians completed the study. Interventionist respondents were more likely to proceed directly to EVT (39.5% vs. 19.5%; p < 0.0001) compared to non-interventionist respondents in patients with favorable ASPECTS (Alberta Stroke Program Early CT Score). Despite no difference in access to advanced imaging, interventionists were more likely to prefer CT/CTA alone (34.8% vs. 21.0%) and less likely to prefer CT/CTA/CTP (39.1% vs. 52.4%) for patient selection (p < 0.0001). When faced with uncertainty, non-interventionists were more likely to follow clinical guidelines (45.1% vs. 30.2%) while interventionists were more likely to follow their assessment of evidence (38.7% vs. 27.0%) (p < 0.0001). Conclusion: Interventionists were less likely to use advanced imaging techniques in selecting LVO patients presenting in the late window and more likely to base their decisions on their assessment of evidence rather than published guidelines. These results reflect gaps between interventionists and non-interventionists reliance on clinical guidelines, the limits of available evidence, and clinician belief in the utility of advanced imaging.

Original languageEnglish
Pages (from-to)801-811
Number of pages11
JournalClinical Neuroradiology
Volume33
Issue number3
DOIs
Publication statusPublished - Sept 2023
Externally publishedYes

Keywords

  • ASPECTS
  • Endovascular thrombectomy
  • Large vessel occlusion
  • Late window
  • Mechanical thrombectomy

Fingerprint

Dive into the research topics of 'Specialist perspectives on the imaging selection of large vessel occlusion in the late window'. Together they form a unique fingerprint.

Cite this