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Proximal Internal Carotid artery Acute Stroke Secondary to tandem Occlusions (PICASSO) international survey
- Source :
- Journal of NeuroInterventional Surgery. 13:1106-1110
- Publication Year :
- 2020
- Publisher :
- BMJ, 2020.
-
Abstract
- BackgroundWhile mechanical thrombectomy (MT) is the standard of care for large vessel occlusion strokes, the optimal management of tandem occlusions (TO) remains uncertain. We aimed to determine the current practice patterns among stroke physicians involved in the treatment of TO during MT.MethodsWe distributed an online survey to neurovascular practitioners (stroke neurologists, neurointerventionalists, neurosurgeons, and radiologists), members of professional societies. After 2 months the site was closed and data were extracted and analyzed. We divided respondents into acute stenting and delayed treatment groups and responses were compared between the two groups.ResultsWe received 220 responses from North America (48%), Latin America (28%), Asia (15%), Europe (5%), and Africa (4%). Preferred timing for cervical revascularization varied among respondents; 51% preferred treatment in a subsequent procedure during the same hospitalization whereas 39% preferred to treat during MT. Angioplasty and stenting (41%) was the preferred technique, followed by balloon angioplasty and local aspiration (38%). The risk of intracerebral hemorrhage was the most compelling reason for not stenting acutely (68%). There were no significant differences among practice characteristics and timing groups. Most practitioners (70%) agreed that there is equipoise regarding the optimal endovascular treatment of cervical lesions in TO; hence, 77% would participate in a randomized controlled trial.ConclusionsThe PICASSO survey demonstrates multiple areas of uncertainty regarding the medical and endovascular management of TOs. Experts acknowledged the need for further evidence and their willingness to participate in a randomized controlled trial to evaluate the best treatment for the cervical TO lesion.
- Subjects :
- medicine.medical_specialty
medicine.medical_treatment
Revascularization
law.invention
Randomized controlled trial
law
Surveys and Questionnaires
medicine.artery
Angioplasty
medicine
Humans
Carotid Stenosis
Stroke
Thrombectomy
Intracerebral hemorrhage
business.industry
Endovascular Procedures
Stent
General Medicine
medicine.disease
Stenosis
Treatment Outcome
Emergency medicine
Stents
Surgery
Neurology (clinical)
Internal carotid artery
business
Carotid Artery, Internal
Subjects
Details
- ISSN :
- 17598486 and 17598478
- Volume :
- 13
- Database :
- OpenAIRE
- Journal :
- Journal of NeuroInterventional Surgery
- Accession number :
- edsair.doi.dedup.....96411f01cda4218567d83d72baa64716