title: Visual aid tool to improve decision making in acute stroke care.
abstract: Background Acute stroke care represents a challenge for decision makers. Recent randomized trials showed the benefits of endovascular therapy. Our goal was to provide a visual aid tool to guide clinicians in the decision process of endovascular intervention in patients with acute ischemic stroke. Methods We created visual plots (Cates' plots; www.nntonline.net ) representing benefits of standard of care vs. endovascular thrombectomy from the pooled analysis of five RCTs using stent retrievers. These plots represent the following clinically relevant outcomes (1) functionally independent state (modified Rankin scale (mRS) 0 to 2 at 90 days) (2) excellent recovery (mRS 0-1) at 90 days, (3) NIHSS 0-2 (4) early neurological recovery, and (5) revascularization at 24 h. Subgroups visually represented include time to treatment and baseline stroke severity strata. Results Overall, 1287 patients (634 assigned to endovascular thrombectomy, 653 assigned to control were included to create the visual plots. Cates' visual plots revealed that for every 100 patients with acute ischemic stroke and large vessel occlusion, 27 would achieve independence at 90 days (mRS 0-2) in the control group compared to 49 (95% CI 43-56) in the intervention group. Similarly, 21 patients would achieve early neurological recovery at 24 h compared to 54 (95% CI 45-63) out of 100 for the intervention group. Conclusion Cates' plots may assist clinicians and patients to visualize and compare potential outcomes after an acute ischemic stroke. Our results suggest that for every 100 treated individuals with an acute ischemic stroke and a large vessel occlusion, endovascular thrombectomy would provide 22 additional patients reaching independency at three months and 33 more patients achieving ENR compared to controls.
authors.affiliation: 1 Stroke Outcomes Research Unit, ( www.sorcan.ca ) Division of Neurology, Department of Medicine, St. Michael's Hospital, University of Toronto, Canada.|2 Neuroeconomics and Social Neuroscience, Department of Economics, University of Zurich, Switzerland.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Saposnik
authors.affiliation: 3 Foothills Medical Center, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Mayank
authors.initials: M
authors.lastname: Goyal
authors.affiliation: 4 Department of Radiology (CM) and Neurology (YR), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Charles
authors.initials: C
authors.lastname: Majoie
authors.affiliation: 5 Department of Neurology, Erasmus MC University Medical Center Rotterdam, The Netherlands.
authors.forename: Diederik
authors.initials: D
authors.lastname: Dippel
authors.affiliation: 4 Department of Radiology (CM) and Neurology (YR), Academic Medical Center, Amsterdam, The Netherlands.
authors.forename: Yvo
authors.initials: Y
authors.lastname: Roos
authors.affiliation: 3 Foothills Medical Center, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Demchuk
authors.affiliation: 3 Foothills Medical Center, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Bijoy
authors.initials: B
authors.lastname: Menon
authors.affiliation: 6 Department of Radiology and Department of Medicine and Neurology, Melbourne Brain Centre, University of Melbourne, Australia.
authors.forename: Peter
authors.initials: P
authors.lastname: Mitchell
authors.affiliation: 6 Department of Radiology and Department of Medicine and Neurology, Melbourne Brain Centre, University of Melbourne, Australia.
authors.forename: Bruce
authors.initials: B
authors.lastname: Campbell
authors.affiliation: 7 Department of Neurosciences, Hospital Germans Trias y Pujol, Barcelona, Spain.
authors.forename: Antoni
authors.initials: A
authors.lastname: Dávalos
authors.affiliation: 8 University of Pittsburgh, Medical Center Stroke Institute, Presbyterian University Hospital, Pittsburgh, PA, USA.
authors.forename: Tudor
authors.initials: T
authors.lastname: Jovin
authors.affiliation: 3 Foothills Medical Center, University of Calgary, Cumming School of Medicine, Calgary, Alberta, Canada.
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
mesh_terms: D000368:Aged; D001296:Audiovisual Aids; D002545:Brain Ischemia / Q000628:therapy; D002548:Cerebral Revascularization; D000066491:Clinical Decision-Making; D003142:Communication; D020000:Decision Support Systems, Clinical; D057510:Endovascular Procedures; D006801:Humans; D057240:Patient Preference; D016032:Randomized Controlled Trials as Topic; D012720:Severity of Illness Index; D020521:Stroke / Q000628:therapy*; D017131:Thrombectomy; D016896:Treatment Outcome
keywords: Acute stroke therapy; decision making; endovascular therapy; outcomes; stroke; tPA; thrombolysis; treatment; visual aid tool