P-002 Perceived limits of endovascular treatment for secondary medium vessel occlusion stroke

Abstract

<h3>Background</h3> Medium-vessel occlusions (MeVOs) account for 25%-40% of all acute ischemic stroke (AIS) cases. With peri-procedural embolization occurring in up to 9% of all EVT cases, secondary MeVOs are of particular interest to neurointerventionalists. There is currently no reliable evidence regarding whether EVT is safe and effective for MeVO strokes. We sought to gain insight into the current management approaches regarding EVT in AIS caused by secondary MeVOs. <h3>Methods</h3> We conducted an international case-based survey (MeVO-Finding Rationales and Objectifying New Targets for IntervEntional Revascularization in Stroke; MeVO-FRONTIERS) among stroke physicians to gain insight into the current management approaches regarding EVT in AIS caused by secondary MeVOs. Survey participants were presented three cases involving secondary MeVO, each consisting of three case-vignettes with differences in the neurological status of the described patient (improvement, no change, unable to assess due to general anaesthesia). Univariate and multivariate logistic regression analyses clustered by respondent identity were performed to assess factors influencing the decision to treat. <h3>Results</h3> 366 physicians (56 women, 308 men, 2 of undisclosed gender) of different specialities from 44 countries completed the survey for a total of 3294 responses. The majority of physicians (54.1%, 1782/3294) were in favor of EVT. Participants were more likely to treat patients if the occlusion site was in the anterior M2/3 (74.3%; risk ratio [RR] 2.62, 95%CI:2.27-3.03) and A3 (59.7%; RR 2.11, 95%CI:1.83-2.42) segments, compared to those in the M3/4 segment (28.3%; reference). An improvement in neurological status led to a significant decrease in the likelihood to pursue EVT compared to patients whose neurological deficit remained unchanged (49.9% versus 57% responses in favor of EVT, respectively; RR 0.88, 95%CI:0.83-0.92). Interventionalists and more experienced physicians were more likely to treat secondary MeVOs. <h3>Conclusion</h3> Our findings suggest that physician’s willingness to treat secondary MeVOs endovascularly is limited and varies per occlusion location and change in neurological status. More evidence on the safety and efficacy of EVT for secondary MeVO stroke is needed. <h3>Disclosures</h3> <b>P. Cimflova:</b> None. <b>R. McDonough:</b> None. <b>M. Kappelhof:</b> None. <b>J. Ospel:</b> None. <b>N. Singh:</b> None. <b>N. Kashani:</b> None. <b>A. Demchuk:</b> None. <b>B. Menon:</b> None. <b>M. Chen:</b> 2; C; Medtronic, Genentech, Stryker, Microvention, Cerenovus, Penumbra. <b>N. Sakai:</b> None. <b>J. Fiehler:</b> None. <b>M. Goyal:</b> 2; C; Mentice, Medtronic, Microvention, Stryker.