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February 20, 2020

Effect of Time of Presentation on Endovascular Treatment Decisions in Acute Stroke Patients

February 19, 2020—An analysis from UNMASK EVT international survey evaluated the relationship of the time of day and endovascular treatment decision-making in acute stroke with relative endovascular treatment indication. Johanna Maria Ospel, MD, et al published the findings in Journal of NeuroInterventional Surgery (2020;12:122–126).

The investigators stated that the background of the study is that the decision to proceed with endovascular thrombectomy should ideally be made independent of inconvenience factors, such as daytime.

As summarized in Journal of NeuroInterventional Surgery, the investigators assessed the influence of patient presentation time on endovascular therapy decision-making under current local resources and assumed ideal conditions in acute ischemic stroke with level 2B evidence for endovascular treatment.

In the international cross-sectional UNMASK EVT survey, 607 stroke physicians from 38 countries were asked to give their treatment decisions to 10 out of 22 randomly assigned case scenarios. Eleven scenarios had level-2B evidence for endovascular treatment, including seven daytime scenarios (7:00 am–5:00 pm) and four night-time cases (5:01 pm–6:59 am).

Participants provided their treatment approach assuming (A) there were no practice constraints and (B) under their current local resources. Endovascular treatment decisions in the 11 scenarios were analyzed according to presentation time with adjustment for patient and physician characteristics.

The investigators reported that participants selected endovascular therapy in 74.2% under assumed ideal conditions, and 70.7% under their current local resources of night-time scenarios, and in 67.2% and 63.8% of daytime scenarios, respectively. Night-time presentation did not increase the probability of a treatment decision against endovascular therapy under current local resources or assumed ideal conditions.

Presentation time did not influence endovascular treatment decision-making in stroke patients in this international survey, concluded the investigators in Journal of NeuroInterventional Surgery.

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