Perceived importance of silent cerebral ischemia following endovascular procedures

Abstract

Purpose: The clinical significance of iatrogenic diffusion-weighted imaging lesions following endovascular procedures is currently not well understood, partly because they do not result in immediate clinical deficits (“silent brain infarcts” [SBI]) and often remain undiagnosed. Conversely, access site complications are well-documented. With the SILENT survey, we sought to gain an understanding of physicians' opinions regarding the relative importance of SBI compared to the more commonly discussed access site complications. Methods: Seven scenarios of access site complications of varying severity were provided. Within each scenario, participants were asked whether they would choose the access site complication or an increasing number of periprocedural SBI. Logistic regression clustered by respondent was performed to assess participant and scenario factors associated with preferential choice of SBI versus access site complications. Results: 67 participants (13 women; 19.4%) provided 469 responses to the survey. The majority (45; 67.2%) were neurointerventionalists. Regardless of scenario, any number of SBI was deemed unacceptable in 42.4% of cases, whereas 10.5% of physicians would accept >15 SBI to avoid any access site complications. Significant group differences for career stage (p=0.001) and specialty (p=0.007) for the number of tolerated SBI were observed. Regression analyses revealed that only hematoma severity was significantly associated with the willingness to accept an increasing number of SBI. Conclusion: In this survey, 4/10 physicians would accept even severe access site complications to avoid any SBI. The perceived importance of SBI among experienced physicians, and the uncertainty regarding their long-term sequelae, support their systematic assessment and reporting.

Keywords

• Silent brain infarcts
• Interventional care
• Site access complications
• Neurointervention