Abstract TP54: Visual Aids for Patient, Family, and Physician Decision Making About Late Imaging-Guided Endovascular Thrombectomy for Acute Ischemic Stroke

Abstract

Background: Speedy decision-making is helpful for optimal outcomes from endovascular thrombectomy (EVT) for acute ischemic stroke (AIS). Visual displays may facilitate rapid review of relevant outcomes with different courses of action, but have not yet been developed for late-presenting patients selected for EVT based on multimodal CT or MR imaging. Methods: From pooled, study-level randomized trial (DAWN and DEFUSE 3) data, 100 person-icon arrays (Kuiper-Marshall personographs) were generated showing beneficial and adverse effects of endovascular thrombectomy for patients with acute cerebral ischemia and large vessel occlusion using (1) automated (algorithmic) and (2) expert-guided joint outcome table specification. Results: Among imaging-selected patients 6-24 hours from last known well, for the full 7-category modified Rankin Scale (mRS), endovascular thrombectomy had number needed to treat to benefit 1.9 (IQR 1.9-2.1) and number needed to harm 40.0 (29.2-58.3). Visual displays of treatment effects among 100 patients showed that, with EVT: 52 patients have better disability outcome, including 32 more achieving functional independence (mRS 0-2); 3 patients have worse disability outcome, including 1 more experiencing severe disability or death (mRS 5-6), mediated by symptomatic intracranial hemorrhage and infarct in new territory. The person-icon figure integrated these outcomes, and early side-effects, in a single display (Figure). Similar features were present in person-icon figures based on a 6-level mRS (levels 5 and 6 combined) rather than 7-level mRS, and giving special emphasis to normal or near-normal outcome (mRS 0-1) rather than functional independence (mR 0-2). Conclusion: Personograph visual decision aids are now available to rapidly educate patients, family, and healthcare providers on the benefits and risks of late, imaging-guided endovascular thrombectomy therapies for acute ischemic stroke.