SIR 2024
Embolization
Kimberly Wei, BS
Medical Student
University of Pennsylvania
Financial relationships: Full list of relationships is listed on the CME information page.
Scott O. Trerotola, MD
Associate Chair and Chief, Interventional Radiology
Perelman School of Medicine at the University of Pennsylvania, Hospital of the University of Pennsylvania
Financial relationships: Full list of relationships is listed on the CME information page.
581 responses were received (8%); 150 were excluded, leaving a total of 431 responses (6%). The Table shows selected responses. In addition, 80% are aware of the bubble filter recommendation while 18% are not. 66% adhere to it while 33% do not. 20% of patients who are aware of the recommendation do not adhere to it. 16% have been refused IV treatment because of no filter. 17% have refused a needed study/treatment because of no filter (Table). 26% had a treatment rescheduled/delayed because of no filter. 67% of delays were at the patient’s discretion versus 41% at the healthcare provider’s. 4% of patients reported having a stroke/TIA while receiving IV therapy. Of these (n=18), none had a permanent neurological defect. When stratifying difficulty of treatment access based on adherence, 48% of patients who chose “never” do not adhere to the recommendation. For the “most of the time,” “half the time,” and “sometimes” options, patients who adhere made up a significantly higher proportion of responses (p< 0.001).
Conclusion: The disadvantages of adhering to the HHT Guidelines air bubble filter recommendation for patients with PAVM may outweigh the advantages in terms of treatment access and patient experience. Many patients already regularly do not use a filter and none had any permanent effect from TIAs. Of patients who do adhere, there is significantly increased incidence of delaying/not receiving needed treatments and studies. Accessing treatment is also more difficult and causes patients frustration. Adherence to the recommendation not only provides minimal benefit, but actually causes patients harm. These results suggest a review of the bubble filter recommendation may be in order.