Current State of Stroke Care in Vietnam

Ton, Duy; Dao, Xuan Co; Luong, Ngoc Khue; Nguyen, Trong Khoa; Nguyen, Huy Thang; Nguyen, Thanh N.

doi:10.1161/svin.121.000331

Cited by 21 publications

(15 citation statements)

References 13 publications

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“…Although half of the neurointerventionalists in the survey were from middle-income countries, there were no participants from low-income countries. This may reflect both the lack of endovascular resources in these countries 44,45 and a sampling bias.…”

Section: Discussionmentioning

confidence: 99%

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Klein

Herning

Drumm

et al. 2023

SVIN

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BACKGROUND Two recent trials demonstrated a benefit for endovascular therapy (EVT) in the treatment of basilar artery occlusion (BAO). In light of the expected increase in the use of EVT for BAO, we sought to understand the technique preferences of neurointerventionalists performing EVT for BAO. METHODS We conducted an international online survey of physician opinions on the use of EVT in BAO between January and March 2022. The survey was distributed through stroke and neurointerventional organizations. Survey questions examined selection of patients for the procedure and the techniques currently used for EVT in BAO. Responses from neurointerventionalists were analyzed. RESULTS More than 3000 participants were invited yielding 1245 respondents, of whom 543 were classified as neurointerventionalists across 52 countries and included in this analysis. Most neurointerventionalists would proceed to EVT for occlusions of the V4 segment, the basilar artery, or the posterior cerebral artery, without regard for prior intravenous thrombolysis. For BAO of embolic etiology, aspiration only thrombectomy was the preferred method of 50.3% of neurointerventionalists. For BAO of intracranial atherosclerotic disease etiology, combined stent retriever and aspiration thrombectomy was the preferred method of 40.5% of neurointerventionalists. The majority of neurointerventionalists (88.0%) would proceed to stenting after 3 or fewer failed passes for patients with BAO of intracranial atherosclerotic disease etiology. In patients undergoing stenting, aspirin and clopidogrel was the most common antiplatelet regime (52.4%). CONCLUSIONS Among the surveyed neurointerventionalists, the most common techniques for EVT of patients with BAO were contact aspiration or combined stent retriever with aspiration thrombectomy. For patients with BAO due to intracranial atherosclerotic disease, the majority of neurointerventionalists were willing to stent and do so most often after 3 or fewer failed passes and with the use of dual antiplatelet medications. Further study is needed to determine the optimal technique for EVT of BAO with or without intracranial atherosclerotic disease. Key Words

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Section: Discussionmentioning

confidence: 99%

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Klein

Herning

Drumm

et al. 2023

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“…Second, while this survey captured many responses from across the globe, clinicians from Africa, South America, Central America, and Oceania were underrepresented. Given that these regions are home to many low-income and middle-income nations where advanced imaging may present an increased burden [ 35 ] due to its high cost, the perceptions of these clinicians can inform the divergent preferences between non-interventionists and interventionists in the acute management of patients with large vessel occlusion stroke presenting in the extended time window. Third, there was no external validation.…”

Section: Discussionmentioning

confidence: 99%

Specialist Perspectives on the Imaging Selection of Large Vessel Occlusion in the Late Window

Klein

Huo²,

Chen

et al. 2023

Clin Neuroradiol

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Background The proper imaging modality for use in the selection of patients for endovascular thrombectomy (EVT) presenting in the late window remains controversial, despite current guidelines advocating the use of advanced imaging in this population. We sought to understand if clinicians with different specialty training differ in their approach to patient selection for EVT in the late time window. Methods We conducted an international survey of stroke and neurointerventional clinicians between January and May 2022 with questions focusing on imaging and treatment decisions of large vessel occlusion (LVO) patients presenting in the late window. Interventional neurologists, interventional neuroradiologists, and endovascular neurosurgeons were defined as interventionists whereas all other specialties were defined as non-interventionists. The non-interventionist group was defined by all other specialties of the respondents: stroke neurologist, neuroradiologist, emergency medicine physician, trainee (fellows and residents) and others. Results Of 3000 invited to participate, 1506 (1027 non-interventionists, 478 interventionists, 1 declined to specify) physicians completed the study. Interventionist respondents were more likely to proceed directly to EVT (39.5% vs. 19.5%; p < 0.0001) compared to non-interventionist respondents in patients with favorable ASPECTS (Alberta Stroke Program Early CT Score). Despite no difference in access to advanced imaging, interventionists were more likely to prefer CT/CTA alone (34.8% vs. 21.0%) and less likely to prefer CT/CTA/CTP (39.1% vs. 52.4%) for patient selection ( p < 0.0001). When faced with uncertainty, non-interventionists were more likely to follow clinical guidelines (45.1% vs. 30.2%) while interventionists were more likely to follow their assessment of evidence (38.7% vs. 27.0%) ( p < 0.0001). Conclusion Interventionists were less likely to use advanced imaging techniques in selecting LVO patients presenting in the late window and more likely to base their decisions on their assessment of evidence rather than published guidelines. These results reflect gaps between interventionists and non-interventionists reliance on clinical guidelines, the limits of available evidence, and clinician belief in the utility of advanced imaging. Supplementary Information The online version of this article (10.1007/s00062-023-01284-0) contains supplementary material, which is available to authorized users.

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“…RESILIENT showed that good outcomes with EVT could be achieved in the public health system of Brazil, serving as a model for other low- or middle-income countries. 28 29…”

Section: History Of Trialsmentioning

confidence: 99%

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

Starikova,

Räty,

Strbian

et al. 2023

Semin Neurol

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The last decade's progress in demonstrating the clinical benefit of endovascular thrombectomy (EVT) in patients with large vessel occlusion stroke has transformed the paradigm of care for these patients. This review presents the milestones in implementing EVT as standard of care, demonstrates the current state of evidence, provides guidance for identifying the candidate patient for EVT, and highlights unsolved and controversial issues. Ongoing trials investigate broadening of EVT indications for patients who present with large core infarction, adjunctive intra-arterial thrombolysis, medium vessel occlusion, low NIHSS, and tandem occlusion.

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Current State of Stroke Care in Vietnam

Cited by 21 publications

References 13 publications

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Basilar Artery Occlusion Thrombectomy Technique: An International Survey of Practice Patterns

Specialist Perspectives on the Imaging Selection of Large Vessel Occlusion in the Late Window

Endovascular Thrombectomy for Anterior Circulation Large Vessel Occlusion Stroke: An Evolution of Trials

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