Patterns of Care in the Diagnosis and Management of Intracranial Atherosclerosis‐Related Large‐Vessel Occlusion: The Rescue‐LVO Survey

Author:

Siddiqui Fazeel M.1ORCID,Fletcher Jeffrey J.2,Elias Augusto E.3,Dandapat Sudeepta4,Kale Sushant P.5,Heiferman Daniel6,Riedy Loren7,Farooqui Mudassir8,Rodriguez‐Calienes Aaron89,Vivanco‐Suarez Juan8,Pandey Aditya S.10,Ortega‐Gutierrez Santiago811

Affiliation:

1. Department of Neuroscience University of Michigan Health‐West Wyoming MI

2. Department of Research University of Michigan Health‐West Wyoming MI

3. Department of Radiology University of Michigan Health‐West Wyoming MI

4. Aurora Neurosciences Innovation Institute Advocate Aurora Health Milwaukee WI

5. Abrazo Health Care Phoenix AZ

6. Department of Neurosurgery Edward‐Elmhurst Health Naperville IL

7. Department of Neurosciences University of Chicago Chicago IL

8. Department of Neurology University of Iowa Carver College of Medicine Iowa City IA

9. Neuroscience, Clinical Effectiveness, and Public Health Research Group Universidad Científica del Sur Lima Peru

10. Department of Neurosurgery University of Michigan Ann Arbor MI

11. Department of Radiology and Neurosurgery University of Iowa Carver College of Medicine Iowa City IA

Abstract

Background We aimed to determine the current practice patterns among neurointerventional practitioners frequently involved in treating intracranial atherosclerosis‐related large‐vessel occlusion (ICAS‐LVO) during mechanical thrombectomy. Methods We conducted an international online survey of neurointerventionalist members of the Society of Vascular and Interventional Neurology and Society of Neurointerventional Surgery. The 28‐question poll evaluated the preferences on diagnosis, treatment, and endovascular approach to ICAS‐LVO. Results A total of 184 individual survey responses were obtained from practicing neurointerventional physicians. Overall, 38.3% reported an incidence of 6% to 10% of ICAS‐LVO during mechanical thrombectomy. Most neurointerventionalists (91%) diagnose ICAS‐LVO after a continued or recurrent occlusion or by the presence of fixed focal stenosis after multiple mechanical thrombectomy attempts. Most respondents (86%) preferred acute treatment of ICAS‐LVO with rescue stenting (RS)±angioplasty. However, in patients who achieved recanalization with a severe fixed focal stenosis, most (58%) recommended primary medical management. The preferred medication during acute RS was intravenous antiplatelet therapy (65%), and after acute RS, it was dual oral antiplatelet therapy (65%). Fear of hemorrhagic complications (74%) was the most compelling reason not to perform RS±angioplasty. Of respondents, 24% were hesitant to randomize patients to acute RS versus medical therapy in a future randomized trial because of the lack of sensitive and specific biomarkers to diagnose ICAS‐LVO before mechanical thrombectomy treatment. Conclusions The findings of this survey highlight the variations in practice in the medical and endovascular management of ICAS‐LVO. In addition, it informs the situation of equipoise in the treatment decision in ICAS‐LVO, which can then be incorporated into the design of future randomized clinical trials.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Cited by 1 articles. 订阅此论文施引文献 订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献

1. The Future of Endovascular Therapy for Intracranial Atherosclerotic Disease;Stroke: Vascular and Interventional Neurology;2024-04-14

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