Evidence map›Paper›PMID 32060567›Full record

ArticleNeuroradiology2020

Endovascular treatment decision-making in acute ischemic stroke patients with large vessel occlusion and low National Institutes of Health Stroke Scale: insights from UNMASK EVT, an international multidisciplinary survey.

Johanna Maria Ospel, Byungmoon Kim, Ji-Hoe Heo, Shinichi Yoshimura, Nima Kashani, Bijoy Menon, Mohammed Almekhlafi, Andrew Demchuk, Michael Hill, Gustavo Saposnik and 1 more

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Article in Neuroradiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed.

  1. Review
  2. Review
  3. Article
  4. Article
  5. Aspiration Thrombectomy in Patients with Large Vessel Occlusion and Mild Stroke: A Single-Center Experience.Medical science monitor : international medical journal of experimental and clinical research · 2021
    Article
  6. Article
  7. Review
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Johanna Maria OspelDepartment of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Byungmoon KimDepartment of Radiology, Severance Stroke Center, Yunsei University College of Medicine, Seoul, South Korea.
Ji-Hoe HeoDepartment of Neurology, Yonsei University College of Medicine, Seoul, South Korea.
Shinichi YoshimuraDepartment of Neurosurgery Hyogo College of Medicine 1-1 Mukogawa, Nishinomiya, Hyogo, Japan.
Nima KashaniDepartment of Radiology, University of Calgary, Calgary, Canada.
Bijoy MenonDepartment of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Mohammed AlmekhlafiDepartment of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Andrew DemchukDepartment of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Michael HillDepartment of Clinical Neurosciences, University of Calgary, Calgary, Canada.
Gustavo SaposnikDivision of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada.
Mayank GoyalDepartment of Clinical Neurosciences, University of Calgary, Calgary, Canada. mgoyal@ucalgary.ca.ORCID http://orcid.org/0000-0001-9060-2109

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeMany 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.

methodsIn 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.

resultsTwo 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).

conclusionDespite 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.

Indexed as

Decision MakingEndovascular ProceduresAgedBrain IschemiaCerebral AngiographyComputed Tomography AngiographyCross-Sectional StudiesFemaleFibrinolytic AgentsHumansInternationalityIschemic StrokeMalePractice Patterns, Physicians'Surveys and QuestionnairesTissue Plasminogen ActivatorFibrinolytic AgentsTissue Plasminogen ActivatorAcute ischemic strokeEndovascular therapyGuidelinesMinor stroke

Identifiers

PMID32060567

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.