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Abstract Details

Challenges in Obtaining Informed Consent for Endovascular Thrombectomy in Acute Stroke: A Survey of Providers
Cerebrovascular Disease and Interventional Neurology
P1 - Poster Session 1 (11:45 AM-12:45 PM)
13-019

To identify challenges that providers face when obtaining informed consent (IC) for endovascular thrombectomy (EVT).
IC is viewed as integral to medical practice and clinical research, particularly when procedures are involved. However, the process can be fraught with significant challenges, especially for time sensitive emergency treatments such as EVT.

Healthcare providers involved in acute stroke care were surveyed from July to December 2023. The questionnaire was created using Qualtrics and distributed via institutional networks, professional societies including the 好色先生 and StrokeNet, and social media.
Among 391 total respondents, 74% were staff physicians, predominantly from the United States (70%) and employed at academic medical centers (76%). The mean duration in clinical practice was 13.1 ±10.6 years. When asked how often there was uncertainty regarding the optimal approach to IC for EVT, responses stated: "never" (35%), "sometimes" (52%), "often" (9%), and "always" (4%). Respondents answered “no” (21%), “yes” (56%), or “unsure” (23%), when asked if their institutions had policies around IC for EVT. Furthermore, 83% stated they never received training at their institutions on the topic. In free-text responses about perceived challenges to IC for EVT, several key themes emerged: time constraints in emergency settings (40%), lack of patient capacity (20%), availability of surrogates/family (15%), communication barriers (10%), institutional practices/policies (10%), and legal/ethical considerations (5%). Respondents stated: “time is brain,” “seems excessive like consent for CPR,” “overly ambitious to provide EVT even outside of guidelines,” “wildly different physician opinions,” and “patients are unusually incapacitated.”

This study underscores the provider uncertainty, lack of specific training, and challenges associated with obtaining IC for EVT in acute stroke care. To address these specific challenges, there is a critical need for standardized training, protocols, and guidelines that can be applied across varied geographical regions and multidisciplinary environments.

Authors/Disclosures
Ali A. Alsarah, MD (University of New Mexico Hospital- Department of Neurology)
PRESENTER 		Dr. Alsarah has nothing to disclose.
Amir A. Mbonde, MD (Mayo Clinic Arizona) Dr. Mbonde has nothing to disclose.
Adam Dmytriw (Massachusetts General Hospital) Adam Dmytriw has nothing to disclose.
Joshua A. Hirsch, MD Dr. Hirsch has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Medtronic. Dr. Hirsch has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Relievant. Dr. Hirsch has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Hirsch has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Sanofi. Dr. Hirsch has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Cerenovus. Dr. Hirsch has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Balt. Dr. Hirsch has received personal compensation in the range of $5,000-$9,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical.
Aneesh B. Singhal, MD, FAAN (Massachusetts General Hospital) An immediate family member of Dr. Singhal has received personal compensation for serving as an employee of Biogen. Dr. Singhal has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Medicolegal Firms. Dr. Singhal has received research support from NIH-NINDS. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received publishing royalties from a publication relating to health care. Dr. Singhal has received personal compensation in the range of $500-$4,999 for serving as a Honorarium (好色先生) with Biogen.
Thabele M. Leslie-Mazwi, MD Dr. Leslie-Mazwi has a non-compensated relationship as a Board Member with American Brain Foundation that is relevant to AAN interests or activities. Dr. Leslie-Mazwi has a non-compensated relationship as a Council Member with American Heart Association/American Stroke Association that is relevant to AAN interests or activities.
Anna K. Bonkhoff, MD (Mass General Brigham) Dr. Bonkhoff has received personal compensation in the range of $500-$4,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for NeuroImage Clinical (Elsevier).
Natalia S. Rost, MD, MPH, FAAN, FAHA (Massachusetts General Hospital) Dr. Rost has received personal compensation in the range of $100,000-$499,999 for serving as an officer or member of the Board of Directors for 好色先生. Dr. Rost has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for Stroke - AHA/ASA Journal. The institution of Dr. Rost has received research support from NIH. Dr. Rost has received publishing royalties from a publication relating to health care.
Aman Patel Aman Patel has received personal compensation in the range of $50,000-$99,999 for serving as a Consultant for Microvention. Aman Patel has received personal compensation in the range of $10,000-$49,999 for serving as a Consultant for Stryker. Aman Patel has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Medtronic. Aman Patel has received personal compensation in the range of $5,000-$9,999 for serving as a Consultant for Penumbra.
Michael Young, MD (Massachusetts General Hospital, Brigham, Harvard) The institution of Dr. Young has received research support from NIH/NINDS. The institution of Dr. Young has received research support from Department of Defense. The institution of Dr. Young has received research support from Chen Institute.
Robert W. Regenhardt, MD, PhD Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Genomadix. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Rapid Medical. Dr. Regenhardt has received personal compensation in the range of $500-$4,999 for serving as an Expert Witness for Johnson and Bell Trial Lawyers. Dr. Regenhardt has received personal compensation in the range of $5,000-$9,999 for serving as an Expert Witness for Buckley, Theroux, Kline, & Cooley Trial Lawyers. The institution of Dr. Regenhardt has received research support from National Institutes of Health. The institution of Dr. Regenhardt has received research support from Society of Vascular and Interventional Neurology. The institution of Dr. Regenhardt has received research support from Heitman Foundation.