P-033 Desired qualities of endovascular tools and barriers to adoption of ideal devices for treating medium vessel occlusions MeVOs. (23rd July 2022)

• Record Type: Journal Article
• Authors: Kashani, N; Cimflova, P; Maria Ospel, J; Kappelhof, M; McDonough, R; Almekhlafi, M; Chen, M; Sakai, N; Fiehler, J; Ahmed, U; Peeling, L; Kelly, M; Goyal, M
• Is Part Of: Journal of neurointerventional surgery. Volume 14(2022)Supplement 1
• Page Start: A70
• Page End: A70
• Publication Date: 2022-07-23
• Subjects: Nervous system -- Surgery -- Periodicals; Cerebrovascular disease -- Surgery -- Periodicals; 617.48
• DOI: 10.1136/neurintsurg-2022-SNIS.105
• Languages: English
• ISSNs: 1759-8478

Abstract

Abstract : Background: Endovascular treatment (EVT) for stroke due to medium vessel occlusion (MeVO) can be technically challenging and specific endovascular tools are needed to safely and effectively recanalize these relatively small and fragile vessels. We aimed to gain insight into availability and desired qualities of endovascular devices used in MeVO strokes and examined barriers to adoption of MeVO EVT in clinical practice on a global scale. Methods: We conducted a case-based international survey among neurointerventionalists. Participants were asked about their preferred first-line technical EVT approach for 7 MeVO stroke scenarios and whether they felt appropriate endovascular tools for MeVO strokes exist and are available to them in their clinical practice. We then examined barriers to adopting MeVO EVT and analyzed them by geographic regions. Results: A total of 263 neuro-interventionists participated, of which 178 [67.7%] provided free text responses on desired qualities of MeVO EVT tools. The majority 121/178 [68%] felt that there was substantial room for improvement regarding existing tools. A large proportion (131/178 [73.6%]) felt they had appropriate access to existing tools. The most commonly mentioned barrier for adopting MeVO EVT in North America was 'awaiting better tools' (9/28 responses [32.1%]), while awaiting better evidence (8/26 responses [30.8%]), and the need for improved 'Funding' 7/26 responses [26.9%]) were the most important barriers in Europe. Those suggesting quality improvements to stent retrievers were much more likely to use them over aspiration devices as their first-line approach (IRR 1.90 p=0.006). In the setting of low availability, operators were much more likely to use a stent-retriever alone (IRR 14.20 p=0.005). Conclusions: The majority of neurointerventionalists felt that dedicated endovascular tools for MeVO EVT can be substantially improved upon. Different world regions face various challenges in adoption of MeVO EVT, but overall, the most important perceived barrier was the fact that physicians are still awaiting better MeVO EVT tools. Disclosures: N. Kashani: None. P. Cimflova: None. J. Maria Ospel: None. M. Kappelhof: None. R. McDonough: None. M. Almekhlafi: None. M. Chen: None. N. Sakai: None. J. Fiehler: None. U. Ahmed: None. L. Peeling: None. M. Kelly: None. M. Goyal: None.