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Efficient Multimodal MRI Evaluation for Endovascular Thrombectomy of Anterior Circulation Large Vessel Occlusion.
- Source :
- Journal of Stroke & Cerebrovascular Diseases; Dec2020, Vol. 29 Issue 12, pN.PAG-N.PAG, 1p
- Publication Year :
- 2020
-
Abstract
- <bold>Background: </bold>MRI and CT modalities are both current standard-of-care options for initial imaging in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). MR provides greater lesion conspicuity and spatial resolution, but few series have demonstrated multimodal MR may be performed efficiently.<bold>Methods: </bold>In a prospective comprehensive stroke center registry, we analyzed all anterior circulation LVO thrombectomy patients between 2012-2017 who: (1) arrived directly by EMS from the field, and (2) had initial NIHSS ≥6. Center imaging policy was multimodal MRI (including DWI/GRE/MRA w/wo PWI) as the initial evaluation in all patients without contraindications, and multimodal CT (including CT with CTA, w/wo CTP) in the remainder.<bold>Results: </bold>Among 106 EMS-arriving endovascular thrombectomy patients, initial imaging was MRI 62.3%, CT in 37.7%. MRI and CT patients were similar in age (72.5 vs 71.3), severity (NIHSS 16.4 v 18.2), and medical history, though MRI patients had longer onset-to-door times. Overall, door-to-needle (DTN) and door-to-puncture (DTP) times did not differ among MR and CT patients, and were faster for both modalities in 2015-2017 versus 2012-2014. In the 2015-2017 period, for MR-imaged patients, the median DTN 42m (IQR 34-55) surpassed standard (60m) and advanced (45m) national targets and the median DTP 86m (IQR 71-106) surpassed the standard national target (90m).<bold>Conclusions: </bold>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 more sensitive lesion identification and spatial resolution, MRI remains a highly viable primary imaging strategy in acute ischemic stroke patients, though further workflow efficiency improvements are desirable. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 10523057
- Volume :
- 29
- Issue :
- 12
- Database :
- Supplemental Index
- Journal :
- Journal of Stroke & Cerebrovascular Diseases
- Publication Type :
- Academic Journal
- Accession number :
- 147070847
- Full Text :
- https://doi.org/10.1016/j.jstrokecerebrovasdis.2020.105271