Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making
Year: 2016
Type: article
Study design: Observational Study
Abstract: BACKGROUND AND PURPOSE: For the STroke Imaging Research (STIR) and VISTA-Imaging Investigators The purpose of this study was to collect precise information on the typical imaging decisions given specific clinical acute stroke scenarios. Stroke centers worldwide were surveyed regarding typical imaging used to work up representative acute stroke patients, make treatment decisions, and willingness to enroll in clinical trials. METHODS: STroke Imaging Research and Virtual International Stroke Trials Archive-Imaging circulated an online survey of clinical case vignettes through its website, the websites of national professional societies from multiple countries as well as through email distribution lists from STroke Imaging Research and participating societies. Survey responders were asked to select the typical imaging work-up for each clinical vignette presented. Actual images were not presented to the survey responders. Instead, the survey then displayed several types of imaging findings offered by the imaging strategy, and the responders selected the appropriate therapy and whether to enroll into a clinical trial considering time from onset, clinical presentation, and imaging findings. A follow-up survey focusing on 6 h from onset was conducted after the release of the positive endovascular trials. RESULTS: We received 548 responses from 35 countries including 282 individual centers; 78% of the centers originating from Australia, Brazil, France, Germany, Spain, United Kingdom, and United States. The specific onset windows presented influenced the type of imaging work-up selected more than the clinical scenario. Magnetic Resonance Imaging usage (27-28%) was substantial, in particular for wake-up stroke. Following the release of the positive trials, selection of perfusion imaging significantly increased for imaging strategy. CONCLUSIONS: Usage of vascular or perfusion imaging by Computed Tomography or Magnetic Resonance Imaging beyond just parenchymal imaging was the primary work-up (62-87%) across all clinical vignettes and time windows. Perfusion imaging with Computed Tomography or Magnetic Resonance Imaging was associated with increased probability of enrollment into clinical trials for 0-3 h. Following the release of the positive endovascular trials, selection of endovascular only treatment for 6 h increased across all clinical vignettes.
Source: International Journal of Stroke
Authors: Marie Luby, Steven J Warach, Gregory W Albers, Jean-Claude Baron, Christophe Cognard, Antoni Dávalos, Geoffrey A Donnan, Jochen B Fiebach, Jens Fiehler, Werner Hacke, Maarten G Lansberg, David S Liebeskind, Heinrich P Mattle, Catherine Oppenheim, Peter D Schellinger, Joanna M Wardlaw, Max Wintermark
Institutions: National Institutes of Health, National Institute of Neurological Disorders and Stroke, The University of Texas Southwestern Medical Center, The University of Texas at Austin, Stanford Medicine, Stanford University, Inserm, University of Cambridge, Sorbonne Paris Cité, Centre Hospitalier Sainte-Anne, Centre for Psychiatry and Neuroscience, Centre Hospitalier Universitaire de Toulouse, Hospital Universitari Germans Trias i Pujol, The University of Melbourne, Florey Institute of Neuroscience and Mental Health, Center for Stroke Research Berlin, Charité – Universitätsmedizin Berlin, University Medical Center Hamburg-Eppendorf, Heidelberg University, University of California, Los Angeles, University of Bern, University Hospital of Bern, Université Paris Descartes, Johannes Wesling Klinikum Minden, University of Edinburgh, Centre Hospitalier Universitaire Vaudois
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: green
Award: G4988861893
OpenAlex ID: W2285057337