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. 2020 Feb;41(2):280-285.
doi: 10.3174/ajnr.A6397. Epub 2020 Jan 30.

Endovascular Treatment Decisions in Patients with M2 Segment MCA Occlusions

M Almekhlafi  1   2   3 , J M Ospel  1   4 , G Saposnik  5   6 , N Kashani  2 , A Demchuk  1   2 , M D Hill  1   2   3 , M Goyal  1   2 , B K Menon  7   2   3
Affiliations

Endovascular Treatment Decisions in Patients with M2 Segment MCA Occlusions

M Almekhlafi et al. AJNR Am J Neuroradiol. 2020 Feb.

Abstract

Background and purpose: Endovascular therapy in acute ischemic stroke is rapidly evolving. We explored physicians' treatment attitudes and practice in patients with acute ischemic stroke due to M2 occlusion, given the absence of Level-1 guidelines.

Materials and methods: We conducted an international multidisciplinary survey among physicians involved in acute stroke care. Respondents were presented with 10 of 22 case scenarios (4 with proximal M2 occlusions and 1 with a small-branch M2 occlusion) and asked about their treatment approach under A) current local resources, and B) assumed ideal conditions (no monetary or infrastructural restraints). Overall treatment decisions were evaluated; subgroup analyses by physician and patient baseline characteristics were performed.

Results: A total of 607 physicians participated. Most of the respondents decided in favor of endovascular therapy in M2 occlusions, both under current local resources and assumed ideal conditions (65.4% versus 69.6%; P = .017). Under current local resources, older patient age (P < .001), longer time since symptom onset (P < .001), high center endovascular therapy volume (P < .001), high personal endovascular therapy volume (P = .005), and neurosurgeons (P < .001) were more likely to favor endovascular therapy. European respondents were less likely to favor endovascular therapy (P = .001). Under assumed ideal conditions, older patient age (P < .001), longer time since symptom onset (P < .001), high center endovascular therapy volume (P = .041), high personal endovascular therapy volume (P = .002), and Asian respondents were more likely to favor endovascular therapy (P = .037). Respondents with more experience (P = .048) and high annual stroke thrombolysis treatment volume (P = .001) were less likely to favor endovascular therapy.

Conclusions: Patients with M2 occlusions are considered appropriate candidates for endovascular therapy by most respondents in this survey, especially by those performing endovascular therapy more often and those practicing in high-volume centers.

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Figures

FIG 1.
FIG 1.
Decision rates in favor of EVT for different occlusion locations (A), decision rates in favor of EVT in M2 segment MCA occlusions for different geographic regions (B), for different specialties (C), and hospital settings (D). Blue dots illustrate decision rates under assumed ideal conditions and red dots decision rates under current local resources. Decision rates under current resources and assuming ideal conditions in North America in (B) were identical. Decision rates under current resources for neurosurgeons were lower than under assumed ideal conditions (C).
FIG 2.
FIG 2.
Decision rates in favor of EVT in patients with M2 segment MCA occlusions by survey respondents across the globe, stratified by country, under current resources (bars), and assumed ideal conditions (black dots).
See this image and copyright information in PMC

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