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Desired Qualities of Endovascular Tools and Barriers to Treating Medium Vessel Occlusion MeVO

Insights from the MeVO-FRONTIERS International Survey

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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 stroke 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. As a part of the survey, participants were asked whether they felt appropriate endovascular tools for MeVO stroke 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 neurointerventionists participated, of which 178 (67.7%) and 83 (31.6%) provided responses on desired qualities of MeVO EVT tools and on barriers to their adoption in local practice, respectively. The majority 121/178 (68%) felt 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 important barriers in Europe.

Conclusion

The majority of surveyed neurointerventionalists felt that dedicated MeVO EVT tools can be substantially improved upon. Different regions face various challenges in adoption of MeVO EVT, but overall, physicians are mostly awaiting better MeVO EVT tools.

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Acknowledgements

The authors are most grateful to all participants of the survey.

Funding

There was no funding for this study.

Author information

Authors and Affiliations

  1. Department of Diagnostic Imaging, Foothills Medical Center, University of Calgary, 1403 29th St.NW, T2N2T9, Calgary, AB, Canada

    Nima Kashani, Petra Cimflova, Johanna M. Ospel, Manon Kappelhof & Mayank Goyal

  2. Department of Neurosurgery, Royal University Hospital, Saskatoon, SK, Canada

    Nima Kashani, Uzair Ahmed, Lissa Peeling & Michael Kelly

  3. Department of Clinical Neurosciences, University of Calgary, Calgary, AB, Canada

    Petra Cimflova, Nishita Singh, Rosalie V. McDonough, Mohammed A. Almekhlafi & Mayank Goyal

  4. Department of Radiology, University Hospital of Basel, Basel, Switzerland

    Johanna M. Ospel

  5. Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands

    Manon Kappelhof

  6. Department of Neurological Sciences, Rush University Medical Center, Chicago, IL, USA

    Michael Chen

  7. Department of Neurosurgery, Kobe City Medical Center General Hospital, Kobe, Japan

    Nobuyuki Sakai

  8. Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Hamburg, Germany

    Jens Fiehler

Authors
  1. Nima Kashani
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  2. Petra Cimflova
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  3. Johanna M. Ospel
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  4. Manon Kappelhof
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  5. Nishita Singh
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  6. Rosalie V. McDonough
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  7. Mohammed A. Almekhlafi
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  8. Michael Chen
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  9. Nobuyuki Sakai
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  10. Jens Fiehler
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  11. Uzair Ahmed
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  12. Lissa Peeling
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  13. Michael Kelly
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  14. Mayank Goyal
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Contributions

Nima Kashani, Petra Cimflova: data interpretation, manuscript drafting and critical revision.

Mayank Goyal, Manon Kappelhof, Petra Cimflova: study concept, data acquisition/analysis/interpretation, critical manuscript revision.

Nishita Singh, Rosalie V. McDonough, Mohammed A. Almekhlafi, Michael Chen, Nobuyuki Sakai, Jens Fiehler, Uzair Ahmed, Lissa Peeling, Michael Kelly: curation and interpretation of the data, critical manuscript revision.

Corresponding author

Correspondence to Mayank Goyal.

Ethics declarations

Conflict of interest

M. Goyal is a consultant for Medtronic, Stryker, Microvention, GE Healthcare, Mentice. Johanna Ospel is a consultant for NicoLab. N. Kashani, P. Cimflova, J.M. Ospel, M. Kappelhof, N. Singh, R.V. McDonough, M.A. Almekhlafi, M. Chen, N. Sakai, J. Fiehler, U. Ahmed, L. Peeling and M. Kelly declare that they have no competing interests.

Ethical standards

This study was approved by the Conjoint Health Research Ethics Board of the University of Calgary (REB20-2086). Informed consent: all survey participants provided written informed consent prior to entering survey data.

Supplementary Information

Exemplary cases shown to the participants in the questionnaire are demonstrated in Suppl. Figure 1-3.

Questions included in the questionnaire related to access to endovascular tools.

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Kashani, N., Cimflova, P., Ospel, J.M. et al. Desired Qualities of Endovascular Tools and Barriers to Treating Medium Vessel Occlusion MeVO. Clin Neuroradiol 33, 155–160 (2023). https://doi.org/10.1007/s00062-022-01196-5

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  • DOI: https://doi.org/10.1007/s00062-022-01196-5

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