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Kashani N, Cimflova P, Ospel JM, Singh N, Almekhlafi MA, Rempel J, Fiehler J, Chen M, Sakai N, Agid R, Heran M, Kappelhof M, Goyal M. Endovascular Device Choice and Tools for Recanalization of Medium Vessel Occlusions: Insights From the MeVO FRONTIERS International Survey. Front Neurol 2021; 12:735899. [PMID: 34603187 PMCID: PMC8480153 DOI: 10.3389/fneur.2021.735899] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Endovascular treatment (EVT) for stroke due to medium vessel occlusion (MeVO) can be technically challenging. Devices and tools are rapidly evolving. We aimed to gain insight into preferences and global perspectives on the usage of endovascular tools in treating MeVOs. Methods: We conducted an international survey with seven scenarios of patients presenting A3, M2/3, M3, M3/4, or P2/3 occlusions. Respondents were asked for their preferred first-line endovascular approach, and whether they felt that the appropriate endovascular tools were available to them. Answers were analyzed by occlusion location and geographical region of practice, using multinomial/binary logistic regression. Results: A total of 263 neurointerventionists provided 1836 responses. The first-line preferences of physicians were evenly distributed among stent-retrievers, combined approaches, and aspiration only (33.2, 29.8, and 26.8%, respectively). A3 occlusions were more often treated with stent-retrievers (RR 1.21, 95% CI: 1.07–1.36), while intra-arterial thrombolysis was more often preferred in M3 (RR 2.47, 95% CI: 1.53–3.98) and M3/4 occlusions (RR 7.71, 95% CI: 4.16–14.28) compared to M2/3 occlusions. Respondents who thought appropriate tools are currently not available more often chose stent retrievers alone (RR 2.07; 95% CI: 1.01–4.24) or intra-arterial thrombolysis (RR 3.35, 95% CI: 1.26–8.42). Physicians who stated that they do not have access to optimal tools opted more often not to treat at all (RR 3.41, 95% CI: 1.11–10.49). Stent-retrievers alone were chosen more often and contact aspiration alone less often as a first-line approach in Europe (RR 2.12, 95% CI: 1.38–3.24; and RR 0.49, 95% CI 0.34–0.70, respectively) compared to the United States and Canada. Conclusions: In EVT for MeVO strokes, neurointerventionalists choose a targeted vessel specific first-line approach depending on the occlusion location, region of practice, and availability of the appropriate tools.
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Affiliation(s)
- Nima Kashani
- Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Petra Cimflova
- Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.,Department of Medical Imaging, St. Anne's University Hospital Brno and Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Johanna M Ospel
- Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.,Department of Radiology, University Hospital of Basel, Basel, Switzerland
| | - Nishita Singh
- Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Mohammed A Almekhlafi
- Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
| | - Jeremy Rempel
- Department of Diagnostic Imaging, University of Alberta Hospital, University of Alberta, Edmonton, AB, Canada
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michael Chen
- Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Nobuyuki Sakai
- Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Ronit Agid
- Department of Neuroradiology, Toronto Western Hospital, Toronto, ON, Canada
| | - Manraj Heran
- Department of Neuroradiology, Vancouver General Hospital, Toronto, ON, Canada
| | - Manon Kappelhof
- Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.,Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, Netherlands
| | - Mayank Goyal
- Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, Calgary, AB, Canada.,Department of Clinical Neurosciences, Foothills Medical Center, University of Calgary, Calgary, AB, Canada
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Romano DG, Frauenfelder G, Caragliano A, Semeraro V, Pitrone A, Bozzi A, Diana F, Buonomo O, Vidali S, Gandini R, Saponiero R, Vinci S. Multicentric Experience with an Intermediate Aspiration Catheter for Distal M2 Ischemic Stroke. J Stroke Cerebrovasc Dis 2020; 29:105389. [DOI: 10.1016/j.jstrokecerebrovasdis.2020.105389] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 09/30/2020] [Accepted: 10/04/2020] [Indexed: 10/23/2022] Open
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