Abstract Body: Introduction: Several recent randomized clinical trials have demonstrated that EVT can improve functional outcomes and decrease mortality in patients with large ischemic cores. Despite these landmark findings, hyperacute decision-making in large core acute ischemic stroke (AIS) remains complex as these patients still experience high rates of disability and mortality. This study aimed to develop a visual decision aid to help patients and families understand the potential benefits and risks of EVT in large core AIS, facilitating more informed and timely decision-making.
Methods: Data from six pivotal trials were pooled to evaluate the global disability outcome distributions based on the 90-day modified Rankin Scale (mRS) for patients undergoing EVT versus medical management. A visual decision tool was created using Kuiper-Marshall personographs to represent these outcomes as icon arrays. Calculations for benefit per hundred (BPH) and harm per hundred (HPH) were performed, factoring in rates of symptomatic intracranial hemorrhage (sICH) and decompressive hemicraniectomy. Net benefit was derived by subtracting HPH from BPH. The visual aid employs color-coded shifts in mRS scores to communicate risks and benefits clearly to patients and their families.
Results: Pooled analysis demonstrated that 2.0% of patients in the EVT group achieved an mRS of 0 compared to 0.3% in the control group. Similarly, higher rates of mRS 1 (6.0% vs. 2.6%), mRS 2 (11.5% vs. 4.6%), and mRS 3 (17.0% vs. 12.5%) were observed in the EVT group compared to the control. Patients in the EVT group also had lower rates of severe disability and death (mRS 4-6), with 31.0% achieving mRS 6 (death) compared to 37.2% in the control group. sICH occurred at a rate of 5.5% in the EVT group versus 3.2% in the control group. Excess treatment harm, combining sICH and hemicraniectomy, was calculated at 4%. Using these pooled data, the BPH for EVT was calculated at 36.1%.
Conclusions: This study highlights the therapeutic potential of EVT in reducing disability and improving functional outcomes for patients with large core AIS. The visual decision aid developed in this study aims to simplify communication of risks and benefits of EVT to patients and their families. By providing a clear, visual representation of potential outcomes, this tool enables better-informed, patient-centered decision-making in emergency settings, ultimately improving care and aligning expectations for all stakeholders.