Insights into variations in preferred selection criteria for acute stroke endovascular therapy

Endovascular thrombectomy (ET) is safe, effective, and cost-effective for large artery occlusion ischemic stroke, even if under different selection criteria.

To study the preferences for ET selection criteria by surveying clinicians and consumers, where number needed to treat to achieve functional independence is the only factor being considered.

A survey providing visual representation of the proportion of patients treated and expected functional outcomes, based on the selection criteria in each of the recent randomized trials of ET, was distributed nationwide in Australia and New Zealand to clinicians and consumers. The preferred selection criteria were identified by the frequency of first choice and using decision-analysis techniques to assess consensus by treating respondents as a panel of experts and aggregating their preferences on selection criteria.

104 clinicians and 107 consumer respondents (43/107 (40%) stroke survivors) took part in the study. Selection criteria of EXTEND-IA were ranked as the most preferred by the consensus process analysis and were the first choice of 64 individual clinicians (61.5%; 95% CI 52% to 71%). ESCAPE trial selection criteria were ranked as the most preferred option and chosen by 42 individual consumers (39%; 95% CI 29% to 48%). Most clinicians based their choice on the ratio of patients benefiting from ET, while consumers considered the absolute number of patients benefiting.

Consumers favor maximization of the absolute number achieving good outcome in comparison with clinicians. This finding suggests that less restrictive criteria may be favored in clinical practice.