Challenges in Obtaining Informed Consent for Endovascular Thrombectomy in Acute Stroke: A Survey of Providers

Challenges in Obtaining Informed Consent for Endovascular Thrombectomy in Acute Stroke: A Survey of Providers
Ali Alsarah, Amir Mbonde, Adam Dmytriw, Joshua Hirshch, Aneesh Singhal, Thabele Leslie-Mazwi, Anna Bonkhoff, Natalia Rost, Aman Patel, Michael Young, Robert Regenhardt
Neurology, 8 April 2025
Abstract
Objective
To identify challenges that providers face when obtaining informed consent (IC) for endovascular thrombectomy (EVT).
Background
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.
Design/Methods
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 American Academy of Neurology and StrokeNet, and social media.
Results
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.”
Conclusions
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.