International survey of acute Stroke imaging used to make revascularization treatment decisions

• Type of Material: Article
• Authors: Max Wintermark, Stanford University; Marie Luby, National Institute of Neurological Disorders and Stroke; Natan M. Bornstein, Tel Aviv University; Andrew Demchuk, University of Calgary; Jens Fiehler, University Medical Center Hamburg-Eppendorf; Kohsuke Kudo, Hokkaido University Hospital; Kennedy R. Lees, University of Glasgow; David S. Liebeskind, University of California Los Angeles; Patrik Michel, University of Lausanne; Raul Nogueira, Emory University; Mark W. Parsons, University of Newcastle; Makoto Sasaki, Iwate Medical University; Joanna M. Wardlaw, University of Edinburgh; Ona Wu, Massachusetts General Hospital; Weiwei Zhang, Military General Hospital of Beijing PLA; Guangming Zhu, Military General Hospital of Beijing PLA; Steven J. Warach, Seton/UT Southwestern Clinical Research Institute of Austin
• Language: English
• Date: 2015-07-01
• Publisher: SAGE Publications (UK and US)
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2015 World Stroke Organization.
• Final Published Version (URL): http://dx.doi.org/10.1111/ijs.12491
• Title of Journal or Parent Work: International Journal of Stroke
• ISSN: 1747-4930
• Volume: 10
• Issue: 5
• Start Page: 759
• End Page: 762
• Keywords: vascular imaging; MRI; CT; ENDOVASCULAR TREATMENT; penumbra; Peripheral Vascular Disease; perfusion imaging; Cardiovascular System & Cardiology; Science & Technology; stroke; TRIAL; ACUTE ISCHEMIC-STROKE; Life Sciences & Biomedicine
• Research Categories: Health Sciences, Medicine and Surgery; Biology, Neuroscience

Abstract

Background To assess the differences across continental regions in terms of stroke imaging obtained for making acute revascularization therapy decisions, and to identify obstacles to participating in randomized trials involving multimodal imaging. Methods Stroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (VISTA)-Imaging circulated an online survey through its website, through the websites of national professional societies from multiple countries as well as through email distribution lists from STIR and the above mentioned societies. Results We received responses from 223 centers (2 from Africa, 38 from Asia, 10 from Australia, 101 from Europe, 4 from Middle East, 55 from North America, 13 from South America). In combination, the sites surveyed administered acute revascularization therapy to a total of 25 326 acute stroke patients in 2012. Seventy-three percent of these patients received intravenous (IV) tissue plasminogen activator (tPA), and 27%, endovascular therapy. Vascular imaging was routinely obtained in 79% (152/193) of sites for endovascular therapy decisions, and also as part of standard IV tPA treatment decisions at 46% (92/198) of sites. Modality, availability and use of acute vascular and perfusion imaging before revascularization varied substantially between geographical areas. The main obstacles to participate in randomized trials involving multimodal imaging included: mainly insufficient research support and staff (50%, 79/158) and infrequent use of multimodal imaging (27%, 43/158). Conclusion There were significant variations among sites and geographical areas in terms of stroke imaging work-up used to make decisions both for intravenous and endovascular revascularization. Clinical trials using advanced imaging as a selection tool for acute revascularization therapy should address the need for additional resources and technical support, and take into consideration the lack of routine use of such techniques in trial planning.