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Related Concept Videos

Peripheral Artery Disease III: Interprofessional Care01:27

Peripheral Artery Disease III: Interprofessional Care

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Peripheral Artery Disease (PAD) is characterized by narrowed arteries that diminish blood flow to the extremities. Effective management of PAD requires an interprofessional approach involving various healthcare professionals. The critical aspects of interprofessional care for PAD patients focus on risk factor modification, drug therapy, exercise therapy, nutrition therapy, critical limb ischemia care, and interventional radiology and surgical procedures.The primary treatment goal for PAD...
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Neurointerventional Practice Change Following Distal Medium Vessel Occlusion Randomized Controlled Trials: A Survey.

Yasmin N Aziz1, Rebeca Aragon Garcia1, Pamela Plummer1

  • 1Department of Neurology and Rehabilitation Medicine, University of Cincinnati, OH (Y.N.A., R.A.G., P.P., I.D., J. P. B., E.A.M.).

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Summary
This summary is machine-generated.

Recent trials found mechanical thrombectomy (MT) ineffective for distal medium vessel occlusions (DMVO) in ischemic stroke. This study surveyed stroke centers, revealing a significant shift in MT treatment decisions for DMVO after trial results were published.

Keywords:
anterior cerebral arteryclinical decision-makingischemic strokemiddle cerebral arterythrombectomy

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Area of Science:

  • Neurology
  • Interventional Neurology
  • Stroke Medicine

Background:

  • Recent randomized trials (RCTs) indicated no benefit from mechanical thrombectomy (MT) for ischemic stroke caused by distal medium vessel occlusion (DMVO).
  • Understanding the impact of these trial results on clinical practice is crucial for optimizing stroke treatment.

Purpose of the Study:

  • To assess the changes in the utilization of MT for DMVO stroke treatment before and after the publication of key randomized trials.
  • To investigate how stroke centers' decision-making processes for MT in DMVO have evolved.

Main Methods:

  • An email survey was distributed to 47 comprehensive stroke centers in the United States participating in an NIH-funded RCT.
  • Site principal investigators responded based on team-based decisions regarding MT for DMVO, differentiating between vessel occlusion locations (nondominant M2 vs. M3/M4/A1/A2) before and after DMVO RCT publication.

Main Results:

  • Before DMVO RCTs, 95% of respondents treated nondominant M2 occlusions with MT; post-RCTs, only 15% continue this practice, with 57.5% making decisions based on additional variables.
  • For other anterior circulation DMVOs, MT use dropped from 50% to 7.5%, with 32.5% now considering other variables.
  • Symptom severity was the most frequently cited variable influencing treatment decisions post-RCTs.

Conclusions:

  • The results of the DMVO RCTs have prompted a significant change in clinical practice at comprehensive stroke centers.
  • Stroke teams are altering their approach to mechanical thrombectomy for anterior circulation DMVO based on recent evidence.