Visual aids for patient, family, and physician decision making about endovascular thrombectomy for acute ischemic stroke

Abstract

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.