Journal article
Patterns of Care in the Diagnosis and Management of Intracranial Atherosclerosis‐Related Large‐Vessel Occlusion: The Rescue‐LVO Survey
Stroke: vascular and interventional neurology, Vol.4(2), e001133
03/2024
DOI: 10.1161/SVIN.123.001133
PMCID: PMC12778479
PMID: 41583588
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.
Details
- Title: Subtitle
- Patterns of Care in the Diagnosis and Management of Intracranial Atherosclerosis‐Related Large‐Vessel Occlusion: The Rescue‐LVO Survey
- Creators
- Fazeel M. Siddiqui - University of MichiganJeffrey J. Fletcher - University of MichiganAugusto E. Elias - University of MichiganSudeepta Dandapat - Aurora Health CareSushant P. Kale - Phoenix (United States)Daniel Heiferman - Edward HospitalLoren Riedy - University of ChicagoMudassir Farooqui - University of IowaAaron Rodriguez-Calienes - University of IowaJuan Vivanco-Suarez - Department of Neurology University of Iowa Carver College of Medicine Iowa City IAAditya S. Pandey - University of MichiganSantiago Ortega-Gutierrez - University of Iowa
- Resource Type
- Journal article
- Publication Details
- Stroke: vascular and interventional neurology, Vol.4(2), e001133
- DOI
- 10.1161/SVIN.123.001133
- PMID
- 41583588
- PMCID
- PMC12778479
- NLM abbreviation
- Stroke Vasc Interv Neurol
- ISSN
- 2694-5746
- eISSN
- 2694-5746
- Language
- English
- Electronic publication date
- 01/25/2024
- Date published
- 03/2024
- Academic Unit
- Neurology; Radiology; Iowa Neuroscience Institute; Neurosurgery
- Record Identifier
- 9984554859902771
Metrics
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