2025 American Academy of Neurology Abstract Website

Amir Mbonde¹, Ali Alsarah², Bart Demaerschalk⁴, Adam Dmytriw⁵, Quentin Moyer³, Joshua Hirsch⁵, Aneesh Singhal⁵, Thabele Leslie-Mazwi⁶, Natalia Rost⁵, Aman Patel⁵, Michael Young⁷, Robert Regenhardt⁵
¹Medical College of Georgia, ²Neurology, Massachussetts General Hospital, ³Massachussetts General Hospital, ⁴Mayo Clinic, ⁵Massachusetts General Hospital, ⁶Neurology, University of Washington, ⁷Massachusetts General Hospital, Brigham, Harvard

Objective:

Investigate the medical specialties and clinical roles of individuals who obtain informed consent (IC) for endovascular thrombectomy (EVT), aiming to provide insights for enhancing the process in contemporary stroke care.

Background:

IC plays a central role in medical care and research. Practices for EVT in acute stroke are not well elucidated, particularly with regard to who obtains IC.

Design/Methods:

A survey was conducted from July to December 2023 among providers involved in acute stroke care. Utilizing Qualtrics, a structured questionnaire was disseminated through various national and international platforms including the American Academy of Neurology and StrokeNet.

Results:

Among 168 participants, 71% were staff physicians, 70% practiced in the United States (US), and 70% were based at academic centers. The most common medical specialties obtaining EVT IC were neurology (77%), followed by neurosurgery (41%), radiology (30%) and emergency medicine (10%). Staff physician (61%) was the most common clinical role involved, followed by fellows (43%), residents (48%), and advanced practice providers (APP, 36%). Non-US institutions were more likely to utilize a provider from neurology alone (50% vs. 31%, p=0.016) and staff physicians (76% vs. 54%, p=0.008), while US institutions were more likely to utilize providers from neurosurgery (51% vs. 18%, p<0.001), APPs (43 vs. 18%, p=0.002) and residents (56% vs. 28%, p=0.001). Non-academic institutions more frequently used emergency medicine providers (25% vs. 5%, p<0.001) and APPs (50% vs. 31%, p=0.031), while academic institutions commonly utilized neurosurgery providers (48% vs. 18%, p=0.001), residents (59% vs. 13%, p<0.001) and fellows (52% vs. 18%, p<0.001).

Conclusions:

This study highlights the diverse medical specialties and clinical roles of persons obtaining IC for EVT. These variations likely reflect provider availability and clinical culture in different settings. Future efforts to optimize the IC process should be multi-disciplinary, with standardized content that addresses provider diversity.