Perceived Limits of Endovascular Treatment for Secondary Medium-Vessel-Occlusion Stroke

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FIGURE.
The effect of occlusion site and patient neurologic status (NS) on EVT decision-making for secondary MeVOs. The frequency of physicians’ responses for treatment options in given scenarios with changing neurological status are listed on vertical axis in the diagram. The evolution in physicians’ decision for endovascular treatment based on the changed neurological status is listed in horizontal fashion. Number of responses for category “Wake up the patient”: M2/M3=16; A3=15; M3/4=22. No values are provided for response frequency of <10.

Endovascular decision-making based on patient neurologic status, stratified by site of occlusion

	Physicians’ Responses to the Question Regarding EVT in Presented MeVO Cases				RR (95%CI)^{^a}
	EVT Yes	Wait for 10 Min and Repeat DSA	Wake Up the Patient for Reassessment	EVT No	RR (95%CI)^{^a}
Decision to treat based on occlusion site
Occlusion site (No.) (%)
Posterior M3/4 MCA	311 (28.3)	189 (17.2)	22 (2.0)	576 (52.5)	Ref.
Anterior M2/3 MCA	816 (74.3)	157 (14.3)	16 (1.5)	109 (9.9)	2.62 (2.27–3.03)^b
A3 ACA	655 (59.7)	190 (17.3)	15 (1.4)	238 (21.7)	2.11 (1.83–2.42)^b
Decision to treat based on occlusion site and neurologic status
Anterior M2/3 MCA (No.) (%)
No improvement	299 (81.7)	42 (11.2)	NA	25 (6.8)	Ref.
Patient improved	245 (66.9)	70 (19.1)	NA	51 (13.9)	0.82 (0.77–0.87)^b
Unknown (GA)	272 (74.3)	45 (12.3)	16 (4.4)	33 (9.0)	0.91 (0.87–0.95)^b
Posterior M3/4 MCA (No.) (%)
No improvement	111 (30.3)	69 (18.9)	NA	186 (50.8)	Ref.
Patient improved	89 (24.3)	66 (18.0)	NA	211 (57.7)	0.80 (0.70–0.92)^b
Unknown (GA)	111 (30.3)	54 (14.8)	22 (6.0)	179 (48.9)	1.00 (0.90–1.11)
A3 ACA (No.) (%)
No improvement	216 (59.0)	67 (18.3)	NA	83 (22.7)	Ref.
Patient improved	214 (58.5)	67 (18.3)	NA	85 (23.2)	0.99 (0.92–1.07)
Unknown (GA)	225 (61.5)	56 (15.3)	15 (4.1)	70 (19.1)	1.04 (0.99–1.10)

Note:—GA indicates general anesthesia; NA, not applicable; Ref., reference; ACA, anterior cerebral artery; Min, minutes.
↵^aResponses to “Wait for 10 minutes and repeat DSA to look for persistent occlusion” and “Wake up the patient for reassessment” (if applicable) were included in the “No EVT” category to calculate risk ratios. Data in columns 2–5 represent the responses of physicians to a survey question “Should the presented MeVO be treated endovascularly?”
↵b P value < .05.