Key result
~86% of stroke physicians prefer combined IVT and EVT for typical LVO stroke.
Why the study?
Factors influencing physicians' treatment choices among intravenous thrombolysis alone, endovascular thrombectomy alone, or combined therapy in acute ischemic stroke with large vessel occlusion are not well understood.
Cross-Sectional (n=282)
Yes
Despite recent trial data, most stroke physicians still prefer combined IVT and EVT for typical LVO stroke, though preference wanes in complex clinical scenarios.
Most physicians prefer combined IVT+EVT; reinforces meta-analytic support for dual therapy but leaves open real-world adoption and outcomes.
BACKGROUND: A recently published individual participant-level meta-analysis found that EVT alone was not non-inferior to combined intravenous thrombolysis (IVT) and EVT. Our aim was to determine factors that influence physicians' treatment choice of IVT-alone versus EVT-alone versus a combined approach. METHODS: We performed an international, structured, invite-only survey among physicians treating patients presenting with AIS. Respondents were asked 16 multiple choice questions. Fourteen questions involved the respondent being provided with a clinical scenario. In each scenario, a patient was presenting with an AIS with LVO, varying a single clinical or imaging feature. RESULTS: A total of 282 stroke physicians (mean age 46 years, 75 % males) participated in the survey. In LVO stroke, eligible for both IVT and EVT, without other qualifiers, 220 (85.9 %) respondents chose to pursue a combined approach. For age over 80 years, 191 (74 %) participants opted for combined approach, which decreased to 121 (48.2 %) with dementia and 148 (57.4 %) if the patient was on dual anti-platelet therapy (DAPT). Of respondents choosing combination therapy in a patient above the age of 80, only 105 (56.8 %) would pursue the same in a patient with dementia. For imaging factors, 177 (72.8 %) opted for a combined approach for intracranial carotid occlusion, which decreased to 160 (65.3 %) in tandem occlusions. Overall, 88 (38 %) respondents agreed to the statement "I am uncomfortable with uncertainty in patient care". CONCLUSIONS: In a typical patient with AIS due to LVO, most respondents still choose a combined revascularization approach but discrepancy in decision-making increases in complex scenarios.
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Siddiqi et al. (2024) conducted a cross-sectional in Physicians treating patients presenting with acute ischemic stroke with large vessel occlusion (n=282). Clinical scenarios of acute ischemic stroke with large vessel occlusion was evaluated on Choice to pursue a combined approach (IVT + EVT) in typical LVO stroke. In an international survey of 282 stroke physicians, 85.9% preferred a combined revascularization approach (IVT and EVT) for typical acute ischemic stroke with large vessel occlusion.
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