Table 2.
Survey responses: interventionist vs. non-interventionist
| Interventionist | Non-interventionist | p | |
|---|---|---|---|
| Q0: 78-year-old woman from assisted living facility (due to mild cognitive impairment, MoCA 20) presents as wake-up stroke, 9 h from last seen well. CT ASPECTS 9. CTA shows left M1 occlusion. How would you manage the patient? | |||
| Complete CTP or MRI prior to EVT | 206 (45.57) | 385 (39.69) | < 0.0001 |
| Complete CTP or MRI prior to combined IVT and EVT | 50 (11.04) | 312 (32.16) | – |
| Direct to EVT | 179 (39.51) | 189 (19.48) | – |
| IVT alone as wake-up stroke | 2 (0.44) | 17 (1.75) | – |
| Medical management | 11 (2.43) | 40 (4.12) | – |
| Refer to EVT center | 5 (1.10) | 27 (2.78) | – |
| Q1: Would you agree to base reperfusion therapies for patients presenting in the late time window (6–24 h) on CT + CTA as opposed to advanced brain imaging (CTP/MRI) done in the DAWN/DEFUSE3 studies? | |||
| I agree with CT/CTA/CTP for patient selection in the late window | 184 (39.07) | 521 (52.41) | < 0.0001 |
| I agree with just CT/CTA modalities for patient selection in late window | 164 (34.82) | 209 (21.03) | – |
| I agree with MRI/MRP for patient selection in the late window | 59 (12.53) | 77 (7.75) | – |
| Given the uncertainty about the best strategy, I make individual decisions | 64 (13.59) | 187 (18.81) | – |
| Q2: When making treatment decisions under uncertainty, which option below are you most comfortable with? | |||
| Following standard of care as established in my region or country | 29 (6.26) | 103 (10.49) | < 0.0001 |
| Following recommendations from current clinical guidelines | 140 (30.24) | 443 (45.11) | – |
| Following your standard clinical practice based on your expertise and evidence | 179 (38.66) | 265 (26.99) | – |
| I do not apply a consistent strategy for every therapeutic decision | 115 (24.84) | 171 (17.41) | – |
| Q3. Is advanced imaging (CTP/MRI) available 24/7 at your institution? | |||
| No, it is not available | 21 (4.56) | 70 (7.14) | 0.2254 |
| No, it is only available on weekdays | 17 (3.69) | 46 (4.69) | – |
| Only available as a special request | 18 (3.90) | 49 (4.99) | – |
| Yes, we use it routinely | 339 (73.54) | 680 (69.32) | – |
| Yes, but it is not always immediately available | 66 (14.32) | 136 (13.86) | – |
| Q4. Do you routinely use advanced imaging (CTP/MRI) at your center for thrombectomy decision making in patients presenting with LVO in the 6–24h time window? | |||
| Advanced imaging (CTP/MRI) is not available | 14 (3.02) | 49 (5.02) | 0.3472 |
| No, we use it in some cases | 121 (26.13) | 239 (24.49) | – |
| Treatment decisions are based on CT/CTA at my institution | 34 (7.34) | 67 (6.86) | – |
| Yes, we use it in every case | 294 (63.50) | 621 (63.63) | – |
| Q5. If you do not have advanced imaging readily available, and a patient presents to you with LVO in the 6–24 h window based on CT/CTA imaging, how do you treat this patient? | |||
| Medical management | 12 (2.69) | 93 (10.01) | < 0.0001 |
| Enroll in RCT | 14 (3.14) | 23 (2.48) | – |
| Refer to EVT based upon CT alone | 373 (83.63) | 591 (63.62) | – |
| Refer to CSC | 19 (4.26) | 147 (15.82) | – |
| Wait for advanced imaging | 28 (6.28) | 75 (8.07) | – |
| Q6. If you use advanced imaging (CTP/MRI) for selecting patients in the 6–24 h window, compared to CT imaging, what additional time does it usually take in your center to obtain these images to decide a patient’s candidacy for thrombectomy? | |||
| 5 min | 101 (24.51) | 206 (24.38) | 0.8431 |
| 10 min | 135 (32.77) | 292 (34.56) | – |
| 20 min | 93 (22.57) | 161 (19.05) | – |
| 30 min | 49 (11.89) | 106 (12.54) | – |
| 45 min | 16 (3.88) | 37 (4.38) | – |
| 60 min | 13 (3.16) | 29 (3.43) | – |
| 90 min | 2 (0.49) | 9 (1.07) | – |
| 120 min | 3 (0.73) | 5 (0.59) | – |
| Q7. If you use advanced imaging (CTP/MRI) for selection of patients in the 6–24 h window, compared to CT imaging, what additional time delay do you believe is acceptable to obtain these images to decide a patient’s candidacy for thrombectomy? | |||
| 0 min | 12 (2.90) | 23 (2.72) | 0.6089 |
| 5 min | 79 (19.08) | 141 (16.69) | – |
| 10 min | 147 (35.51) | 295 (34.91) | – |
| 20 min | 80 (19.32) | 201 (23.79) | – |
| 30 min | 65 (15.70) | 139 (16.45) | – |
| 45 min | 8 (1.93) | 14 (1.66) | – |
| 60 min | 15 (3.62) | 24 (2.84) | – |
| 90 min | 3 (0.72) | 3 (0.36) | – |
| 120 min | 5 (1.21) | 5 (0.59) | – |
| Q8. The RESCUE Japan study showed benefit for endovascular therapy compared to medical management in the treatment of patients in Japan with large core infarct (ASPECTS 3–5), up to 24 h from symptom onset. Most patients in this study (86%) were selected by MRI. A 70-year-old patient presents 7 h from symptom onset, NIHSS 17, left M1 occlusion, CT ASPECTS 4. How would you next manage this patient? | |||
| CTP, then triage | 129 (31.31) | 324 (37.72) | 0.0692 |
| Direct to angio for thrombectomy | 61 (14.81) | 87 (10.13) | – |
| I would randomize into an ongoing large core infarct trial | 103 (25.00) | 204 (23.75) | – |
| Medical management | 58 (14.08) | 122 (14.20) | – |
| MRI, then triage | 61 (14.81) | 122 (14.20) | – |