Open AccessInternational survey of acute S troke imaging used to make revascularization treatment decisions
Author(s) -
Wintermark Max,
Luby Marie,
Bornstein Natan M.,
Demchuk Andrew,
Fiehler Jens,
Kudo Kohsuke,
Lees Kennedy R.,
Liebeskind David S.,
Michel Patrik,
Nogueira Raul G.,
Parsons Mark W.,
Sasaki Makoto,
Wardlaw Joanna M.,
Wu Ona,
Zhang Weiwei,
Zhu Guangming,
Warach Steven J.
Publication year - 2015
Publication title -
international journal of stroke
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.375
H-Index - 74
eISSN - 1747-4949
pISSN - 1747-4930
DOI - 10.1111/ijs.12491
Subject(s) - medicine , revascularization , acute stroke , stroke (engine) , clinical trial , tissue plasminogen activator , perfusion scanning , randomized controlled trial , thrombolysis , radiology , surgery , perfusion , mechanical engineering , myocardial infarction , engineering
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 ST roke I maging R epository ( STIR ) and V irtual I nternational S troke T rials A rchive ( 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 A ustralia, 101 from E urope, 4 from M iddle E ast, 55 from N orth A merica, 13 from S outh A merica). 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 tomake 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.