TY - JOUR
T1 - Visual aids for patient, family, and physician decision making about endovascular thrombectomy for acute ischemic stroke
AU - Tokunboh, Ivie
AU - Montero, Marta Vales
AU - Almeida, Matheus Fellipe Zopelaro
AU - Sharma, Latisha
AU - Starkman, Sidney
AU - Szeder, Viktor
AU - Jahan, Reza
AU - Liebeskind, David
AU - Gonzalez, Nestor
AU - Demchuk, Andrew
AU - Froehler, Michael T.
AU - Goyal, Mayank
AU - Lansberg, Maarten G.
AU - Lutsep, Helmi
AU - Schwamm, Lee
AU - Saver, Jeffrey L.
N1 - Funding Information:
Dr Demchuk received honoraria from Medtronic for continuing medical education lectures. Dr Froehler is a consultant to Medtronic, Stryker, Control Medical, and Blockade/Balt Medical. Dr Goyal is a consultant to Medtronic, Stryker, Microvention, and Ablynx. Dr Jahan is a consultant to Medtronic Neurovascular. Dr Liebeskind is a consultant to Stryker and Medtronic. Dr Lutsep is on the Executive Committee for the National Institute of Neurological Disorders and Stroke–funded DEFUSE3 trial (Endovascular Therapy Following Imaging Evaluation for Ischemic Stroke 3). Dr Starkman is a site investigator in multicenter trials supported by the National Institutes of Health, Stryker, Biogen IDEC, Neuravi, Genentech, Covidien, and Astra-Zeneca. University of California (UC) Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled. The University of California has patent rights in retrieval devices for stroke. Dr Saver has served as an unpaid site investigator in multicenter trials run by Medtronic and Stryker for which the UC Regents received payments on the basis of clinical trial contracts for the number of subjects enrolled. Dr Saver receives funding for services as a scientific consultant regarding trial design and conduct to Medtronic, Stryker, Neuravi, and Boehringer Ingelheim (prevention only). Dr Saver is an employee of the University of California: the University of California has patent rights in retrieval devices for stroke. Dr Schwamm reports research support from National Institutes of Health for the MR Witness trial for which Genentech provided alteplase free of charge and modest site supplemental payments; serves as a consultant in in the atrial fibrillation trial design for Medtronic. I. Tokunboh is an employee of the University of California: the University of California has patent rights in retrieval devices for stroke. The other authors report no conflicts.
PY - 2018
Y1 - 2018
N2 - Background and Purpose-Rapid decision making optimizes outcomes from endovascular thrombectomy for acute cerebral ischemia. Visual displays facilitate swift review of potential outcomes and can accelerate decision processes. Methods-From patient-level, pooled randomized trial data, 100 person-icon arrays (Kuiper-Marshall personographs) were generated showing benefcial 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 specifcation. Results-For the full 7-category modifed Rankin Scale, thrombectomy added to IV tPA (intravenous tissue-type plasminogen activator) alone had number needed to treat to beneft 2.9 (95% confdence interval, 2.6-3.3) and number needed to harm 68.9 (95% confdence interval, 40-250); thrombectomy for patients ineligible for IV tPA had number needed to treat to beneft 2.3 (95% confdence interval, 2.1-2.5) and number needed to harm 100 (95% confdence interval, 62.5-250). Visual displays of treatment effects on 100 patients showed: With thrombectomy added to IV tPA alone, 34 patients have better disability outcome, including 14 more normal or near normal (modifed Rankin Scale, 0-1); with thrombectomy for patients ineligible for IV tPA, 44 patients have a better disability outcome, including 16 more normal or nearly normal. Displays also showed that harm (increased modifed Rankin Scale fnal disability) occurred in 1 of 100 patients in both populations, mediated by increased new territory infarcts. The person-icon fgures integrated these outcomes, and early side-effects, in a single display. Conclusions-Visual decision aids are now available to rapidly educate healthcare providers, patients, and families about benefts and risks of endovascular thrombectomy, both when added to IV tPA in tPA-eligible patients and as the sole reperfusion treatment in tPA-ineligible patients.
AB - Background and Purpose-Rapid decision making optimizes outcomes from endovascular thrombectomy for acute cerebral ischemia. Visual displays facilitate swift review of potential outcomes and can accelerate decision processes. Methods-From patient-level, pooled randomized trial data, 100 person-icon arrays (Kuiper-Marshall personographs) were generated showing benefcial 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 specifcation. Results-For the full 7-category modifed Rankin Scale, thrombectomy added to IV tPA (intravenous tissue-type plasminogen activator) alone had number needed to treat to beneft 2.9 (95% confdence interval, 2.6-3.3) and number needed to harm 68.9 (95% confdence interval, 40-250); thrombectomy for patients ineligible for IV tPA had number needed to treat to beneft 2.3 (95% confdence interval, 2.1-2.5) and number needed to harm 100 (95% confdence interval, 62.5-250). Visual displays of treatment effects on 100 patients showed: With thrombectomy added to IV tPA alone, 34 patients have better disability outcome, including 14 more normal or near normal (modifed Rankin Scale, 0-1); with thrombectomy for patients ineligible for IV tPA, 44 patients have a better disability outcome, including 16 more normal or nearly normal. Displays also showed that harm (increased modifed Rankin Scale fnal disability) occurred in 1 of 100 patients in both populations, mediated by increased new territory infarcts. The person-icon fgures integrated these outcomes, and early side-effects, in a single display. Conclusions-Visual decision aids are now available to rapidly educate healthcare providers, patients, and families about benefts and risks of endovascular thrombectomy, both when added to IV tPA in tPA-eligible patients and as the sole reperfusion treatment in tPA-ineligible patients.
KW - Decision making
KW - Decision support techniques
KW - Health personnel
KW - Reperfusion
KW - Thrombectomy
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U2 - 10.1161/STROKEAHA.117.018715
DO - 10.1161/STROKEAHA.117.018715
M3 - Article
C2 - 29222229
AN - SCOPUS:85043726406
VL - 49
SP - 90
EP - 97
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 1
ER -