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Endovascular Treatment Decision Making in Patients with Low Baseline ASPECTS: Insights from UNMASK EVT, an International Multidisciplinary Study
DC Field | Value | Language |
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dc.contributor.author | 허지회 | - |
dc.date.accessioned | 2021-09-29T00:26:37Z | - |
dc.date.available | 2021-09-29T00:26:37Z | - |
dc.date.issued | 2020-12 | - |
dc.identifier.issn | 1052-3057 | - |
dc.identifier.uri | https://ir.ymlib.yonsei.ac.kr/handle/22282913/183833 | - |
dc.description.abstract | Background: Current stroke treatment guidelines restrict level 1A recommendations for endovascular therapy to patients with baseline ASPECTS score > 5. However, a recent meta-analysis from the HERMES-group showed treatment benefit in patients with ASPECTS ≤ 5. We aimed to explore how physicians across different specialties and countries approach endovascular treatment decision-making in acute ischemic stroke patients with low baseline ASPECTS. Methods: In a multidisciplinary survey, 607 stroke physicians were randomly assigned 10 out of a pool of 22 case-scenarios, 3 of which involved patients with low baseline ASPECTS (A:40-year old with ASPECTS 4, B:33-year old with ASPECTS 2 C:72-year old with ASPECTS 3), otherwise fulfilling all EVT-eligibility criteria. Participants were asked how they would treat the patient A) under their current local resources and B) under assumed ideal conditions, without any external (monetary, policy-related or infrastructural) restraints. Overall and scenario-specific decision rates were calculated. Clustered multivariable logistic regression analysis was used to determine the association of baseline ASPECTS with endovascular treatment-decision. Results: Baseline ASPECTS score was significantly associated with current (OR:1.09, CI 1.05-1.13) and ideal endovascular treatment-decision (OR:1.12, CI 1.08-1.16). Overall current and ideal treatment decision-rates for the low ASPECTS scenarios were 57.1% and 57.6%. Current and ideal rates for the two younger patients were higher (scenario A:69.9/60.4%, scenario B:60.0/61.5%) compared to the 72-year old patient (41.3/40.2%). Conclusion: Most physicians decided to proceed with endovascular treatment despite low baseline ASPECTS, particularly in younger patients. This may have implications on the design and execution of low ASPECTS randomized trials. | - |
dc.description.statementOfResponsibility | restriction | - |
dc.language | English | - |
dc.publisher | Saunders | - |
dc.relation.isPartOf | JOURNAL OF STROKE & CEREBROVASCULAR DISEASES | - |
dc.rights | CC BY-NC-ND 2.0 KR | - |
dc.subject.MESH | Adult | - |
dc.subject.MESH | Age Factors | - |
dc.subject.MESH | Aged | - |
dc.subject.MESH | Clinical Decision Rules* | - |
dc.subject.MESH | Clinical Decision-Making* | - |
dc.subject.MESH | Cross-Sectional Studies | - |
dc.subject.MESH | Endovascular Procedures* | - |
dc.subject.MESH | Female | - |
dc.subject.MESH | Health Care Surveys | - |
dc.subject.MESH | Healthcare Disparities | - |
dc.subject.MESH | Humans | - |
dc.subject.MESH | Male | - |
dc.subject.MESH | Middle Aged | - |
dc.subject.MESH | Patient Selection* | - |
dc.subject.MESH | Practice Patterns, Physicians' | - |
dc.subject.MESH | Predictive Value of Tests | - |
dc.subject.MESH | Risk Assessment | - |
dc.subject.MESH | Risk Factors | - |
dc.subject.MESH | Stroke / diagnosis | - |
dc.subject.MESH | Stroke / physiopathology | - |
dc.subject.MESH | Stroke / therapy* | - |
dc.title | Endovascular Treatment Decision Making in Patients with Low Baseline ASPECTS: Insights from UNMASK EVT, an International Multidisciplinary Study | - |
dc.type | Article | - |
dc.contributor.college | College of Medicine (의과대학) | - |
dc.contributor.department | Dept. of Neurology (신경과학교실) | - |
dc.contributor.googleauthor | Johanna Maria Ospel | - |
dc.contributor.googleauthor | Ravinder Singh | - |
dc.contributor.googleauthor | Nima Kashani | - |
dc.contributor.googleauthor | Mohammed Almekhlafi | - |
dc.contributor.googleauthor | Alexis Wilson | - |
dc.contributor.googleauthor | Urs Fischer | - |
dc.contributor.googleauthor | Bruce Campbell | - |
dc.contributor.googleauthor | Shinichi Yoshimura | - |
dc.contributor.googleauthor | Francis Turjman | - |
dc.contributor.googleauthor | Pillai Sylaja | - |
dc.contributor.googleauthor | Ji-Hoe Heo | - |
dc.contributor.googleauthor | Michael D Hill | - |
dc.contributor.googleauthor | Gustavo Saposnik | - |
dc.contributor.googleauthor | Mayank Goyal | - |
dc.contributor.googleauthor | Bijoy Menon | - |
dc.identifier.doi | 10.1016/j.jstrokecerebrovasdis.2020.105411 | - |
dc.contributor.localId | A04369 | - |
dc.relation.journalcode | J01759 | - |
dc.identifier.eissn | 1532-8511 | - |
dc.identifier.pmid | 33254375 | - |
dc.identifier.url | https://www.sciencedirect.com/science/article/pii/S1052305720308296 | - |
dc.subject.keyword | Acute ischemic stroke | - |
dc.subject.keyword | Aspects | - |
dc.subject.keyword | Endovascular treatment | - |
dc.subject.keyword | Thrombectomy | - |
dc.contributor.alternativeName | Heo, Ji Hoe | - |
dc.contributor.affiliatedAuthor | 허지회 | - |
dc.citation.volume | 29 | - |
dc.citation.number | 12 | - |
dc.citation.startPage | 105411 | - |
dc.identifier.bibliographicCitation | JOURNAL OF STROKE & CEREBROVASCULAR DISEASES, Vol.29(12) : 105411, 2020-12 | - |
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