Efficient Multimodal MRI Evaluation for Endovascular Thrombectomy of Anterior Circulation Large Vessel Occlusion
Section snippets
Methods
In a prospectively maintained comprehensive stroke center registry, we analyzed all anterior circulation AIS-LVO thrombectomy patients: (1) arriving directly by EMS transport from the field, (2) with initial NIHSS ≥6, between 2012–2017. This study received approval from our institutional review board with waiver of the need for patient consent. Throughout this period, the Center's policy was to obtain multimodal MRI as the initial imaging modality in all patients meeting the criteria for
Results
From 2012–2017, 1831 AIS was evaluated, of which 200 consecutive AIS-LVO underwent mechanical thrombectomy. Among those, 106 patients were EMS-arriving and anterior circulation. The initial imaging modality was MRI in 62.3% and CT in 37.7%. Demographics and clinical characteristics of MRI and CT patients are shown separately for the periods 2012–2014 and 2015–2017 in Table I and combined across years 2012–2017 in Supplemental Table I. MR and CT patients were similar in age, vascular risk
Discussion
The leading finding of this study is that magnetic resonance imaging can serve as the first and only imaging modality in EMS-arriving patients presenting with acute ischemic stroke due to large vessel occlusion in a time efficient manner. Among patients imaged with the MR strategy, median door-to-needle times greatly and median door-to-puncture times moderately surpassed national guideline targets. These findings indicate that the greater insights into patient-specific pathophysiology and
Conclusion
AIS-LVO patients can be evaluated by multimodal MR imaging with care speeds faster than national recommendations for door-to-needle and door-to-puncture times. With its greater pathophysiologic insight, MRI remains a highly viable primary imaging strategy in acute ischemic stroke patients, though further workflow efficiency improvements are desirable.
Disclosures:
None reported for all authors.
Conflict of Interest
No conflict of interest for all authors.
References (21)
- et al.
Endovascular thrombectomy after large-vessel ischaemic stroke: a meta-analysis of individual patient data from five randomised trials
Lancet
(2016) - et al.
Comparative sensitivity of computed tomography vs. Magnetic resonance imaging for detecting acute posterior fossa infarct
J Emerg Med
(2012) - et al.
Effect of treatment delay, age, and stroke severity on the effects of intravenous thrombolysis with alteplase for acute ischaemic stroke: a meta-analysis of individual patient data from randomised trials
Lancet
(2014) - et al.
Results of a 1-year quality-improvement process to reduce door-to-needle time in acute ischemic stroke with mri screening
Rev Neurol
(2017) - et al.
Heart disease and stroke statistics-2018 update: a report from the American heart Association
Circulation
(2018) - et al.
Ischemic strokes due to large-vessel occlusions contribute disproportionately to stroke-related dependence and death: a review
Front Neurology
(2017) - et al.
Guidelines for the early management of patients with acute ischemic stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association
Stroke
(2013) - et al.
Recommendations for imaging of acute ischemic stroke: a scientific statement from the american heart association
Stroke
(2009) - et al.
In patients with suspected acute stroke, CT perfusion-based cerebral blood flow maps cannot substitute for DWI in measuring the ischemic core
PLoS One
(2017) - et al.
Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis
JAMA
(2016)
Cited by (1)
Impact of Coronavirus Disease 2019 on Time Delay and Functional Outcome of Mechanical Thrombectomy in Tokyo, Japan
2021, Journal of Stroke and Cerebrovascular DiseasesCitation Excerpt :In addition, medical staff suddenly had to wear unfamiliar personal protective equipment, which could help explain the delay in door (H1) to door (H2) time. The difference in D2P time in the subgroup analysis from October to December 2020, during the peak of the third wave, cannot fully be explained by other predictors (e.g., transfer, iv-rtPA, diagnostic modality for occluded vessels, anesthesia) since these factors did not indicate any imbalances; and although CTA may require less time than MRA, the diagnostic modality for occluded vessels (MRA or CTA) was not found to be a predictor of D2P time in a previous study16; thus, it could be explained by the different protocols and systems in each hospital, information on which was not collected in the present study. However, D2P time was not significantly different for the entire study period, so we may conclude that the COVID-19 pandemic did not affect the initial management in each hospital.