Abstract TP065: Patient, Surrogate, and Provider Perspectives in Cerebrovascular Reperfusion Therapy

Abstract

Introduction: Cerebrovascular reperfusion therapies are essential in treating ischemic stroke, but the urgency of decision-making often requires expedited consent, potentially limiting patient or surrogate understanding of risks, benefits, and expectations. Evaluating consent adequacy may help improve comprehension and shared decision-making during time-sensitive interventions. Methods: This single-institution cross-sectional study examined the consent process for reperfusion therapy from the perspectives of patients, surrogates, and clinicians. 34 patients (or surrogates) undergoing acute thrombolysis with tenecteplase (TNK) and 45 patients (or surrogates) undergoing elective neuroendovascular procedure (cerebral aneurysm embolization or digital subtraction angiography), completed a validated consent adequacy survey within five days of treatment (June 2024–June 2025). Survey domains included therapy received, consent type, communication adequacy, satisfaction, and post-procedure assessments. Results: All patients felt informed regarding major risks. However, elective neuroendovascular procedure participants reported significantly greater understanding of minor risks (93.3% vs. 55.9%, p=0.001), future management (88.9% vs. 64.7%, p<0.001), technical details (96.5% vs. 25%), and long-term quality-of-life effects (77.8% vs. 52.9%, p=0.02) compared with TNK recipients. No group differences were noted regarding short-term outcomes (p=0.27), consequences of non-treatment (p=0.53), or provider qualifications (96.2%). Physician surveys showed high confidence in timely, comprehensive communication, with 98.7% reporting adequate time for discussion and 92.4% confident in patient/surrogate comprehension; none reached statistical significance. Conclusion: While both acute TNK and elective neuroendovascular procedure patients felt informed about major risks and physician qualifications, elective neuroendovascular procedure patients demonstrated greater comprehension of minor risks, technical details, future management, and long-term quality-of-life effects. Physician-reported communication was consistently strong, though patient understanding varied by treatment urgency. These findings highlight the need for tailored consent strategies in acute reperfusion settings to optimize informed decision-making.

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