Frequency of inter-specialty consensus decisions and adherence to advice following discussion at a weekly neurovascular multidisciplinary meeting

Chika Offiah; Sean Tierney; Bridget Egan; Ronán D Collins; Daniel J Ryan; Allan J McCarthy; Deirdre R Smith; James Mahon; Emily Boyle; Holly Delaney; Rory O 'Donohoe; Alison Hurley; Richard A Walsh; Sinead M Murphy; Petya Bogdanova-Mihaylova; Sean O 'Dowd; Mark J Kelly; Taha Omer; Tara Coughlan; Desmond O'Neill; Mary Martin; Stephen J X Murphy; Dominick J H McCabe

doi:10.1007/s11845-023-03319-4

Frequency of inter-specialty consensus decisions and adherence to advice following discussion at a weekly neurovascular multidisciplinary meeting

Ir J Med Sci. 2023 Dec;192(6):3051-3062. doi: 10.1007/s11845-023-03319-4. Epub 2023 Apr 21.

Authors

Chika Offiah^{1

2}, Sean Tierney³, Bridget Egan³, Ronán D Collins^{2

4}, Daniel J Ryan^{2

4}, Allan J McCarthy^{1

2}, Deirdre R Smith^{1

5}, James Mahon^{2

4}, Emily Boyle³, Holly Delaney⁶, Rory O 'Donohoe⁶, Alison Hurley⁶, Richard A Walsh¹, Sinead M Murphy^{1

2

7}, Petya Bogdanova-Mihaylova¹, Sean O 'Dowd¹, Mark J Kelly^{1

2}, Taha Omer^{1

2}, Tara Coughlan^{2

4}, Desmond O'Neill^{2

4}, Mary Martin⁸, Stephen J X Murphy^{1

2}, Dominick J H McCabe^{9

10

11

12

13

14}

Affiliations

¹ Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
² Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
³ Dept. of Vascular Surgery, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
⁴ Dept. of Age-Related Health Care, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
⁵ Vascular Neurology Research Foundation, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
⁶ Dept. of Radiology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland.
⁷ Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland.
⁸ Dept. of Geriatric and Stroke Medicine, Naas General Hospital, Naas, Ireland.
⁹ Dept. of Neurology, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland. dominick.mccabe@tuh.ie.
¹⁰ Stroke Service, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland. dominick.mccabe@tuh.ie.
¹¹ Vascular Neurology Research Foundation, Tallaght University Hospital (TUH) / The Adelaide and Meath Hospital, Dublin, incorporating the National Children's Hospital (AMNCH), Dublin, Ireland. dominick.mccabe@tuh.ie.
¹² Dept. of Clinical Neurosciences, Royal Free Campus, UCL Queen Square Institute of Neurology, London, UK. dominick.mccabe@tuh.ie.
¹³ Academic Unit of Neurology, School of Medicine, Trinity College Dublin, Dublin, Ireland. dominick.mccabe@tuh.ie.
¹⁴ Vascular Neurology Research Foundation, c/o Department of Neurology, Tallaght University Hospital /AMNCH, Tallaght, Dublin, 24, Ireland. dominick.mccabe@tuh.ie.

Abstract

Background/aims: Data are limited on the frequency of 'consensus decisions' between sub-specialists attending a neurovascular multidisciplinary meeting (MDM) regarding management of patients with extracranial carotid/vertebral stenoses and post-MDM 'adherence' to such advice.

Methods: This prospective audit/quality improvement project collated prospectively-recorded data from a weekly Neurovascular/Stroke Centre MDM documenting the proportion of extracranial carotid/vertebral stenosis patients in whom 'consensus management decisions' were reached by neurologists, vascular surgeons, stroke physicians-geriatricians and neuroradiologists. Adherence to MDM advice was analysed in asymptomatic carotid stenosis (ACS), symptomatic carotid stenosis (SCS), 'indeterminate symptomatic status stenosis' (ISS) and vertebral artery stenosis (VAS) patients, including intervals between index event to MDM + / - intervention.

Results: One hundred fifteen patients were discussed: 108 with carotid stenosis and 7 with VAS. Consensus regarding management was noted in 96.5% (111/115): 100% with ACS and VAS, 96.2% with SCS and 92.9% with ISS. Adherence to MDM management advice was 96.4% (107/111): 100% in ACS, ISS and VAS patients; 92% (46/50) in SCS patients. The median interval from index symptoms to revascularisation in 50-99% SCS patients was 12.5 days (IQR: 9-18.3 days; N = 26), with a median interval from MDM to revascularisation of 5.5 days (IQR: 1-7 days). Thirty patients underwent revascularisation. Two out of twenty-nine patients (6.9%) with either SCS or ISS had a peri-procedural ipsilateral ischaemic stroke, with no further strokes/deaths during 3-months follow-up.

Conclusions: The high frequency of inter-specialty consensus regarding management and adherence to proposed treatment supports a collaborative/multidisciplinary model of care in patients with extracranial arterial stenoses. Service development should aim to shorten times between MDM discussion-intervention and optimise prevention of stroke/death.

Keywords: Carotid endarterectomy and endovascular treatment; Neurovascular multidisciplinary team meeting; Optimal medical therapy; Stroke; TIA.

MeSH terms

Brain Ischemia*
Carotid Stenosis* / surgery
Consensus
Constriction, Pathologic / etiology
Endarterectomy, Carotid*
Humans
Risk Factors
Stroke* / prevention & control
Treatment Outcome