Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Purpose: For the STroke Imaging Research (STIR) and VISTA-Imaging InvestigatorsThe 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.

Original languageEnglish (US)
Pages (from-to)180-190
Number of pages11
JournalInternational Journal of Stroke
Volume11
Issue number2
DOIs
StatePublished - Feb 1 2016

Fingerprint

Decision Making
Stroke
Clinical Trials
Perfusion Imaging
Magnetic Resonance Imaging
Therapeutics
Tomography
Research
Spain
France
Germany
Brazil
Blood Vessels
Surveys and Questionnaires

Keywords

  • clinical trial
  • Computed Tomography scan
  • ischemic stroke
  • Magnetic Resonance Imaging
  • stroke
  • thrombolysis

ASJC Scopus subject areas

  • Neurology

Cite this

Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making. / Luby, Marie; Warach, Steven J.; Albers, Gregory W.; Baron, Jean Claude; Cognard, Christophe; Dávalos, Antoni; Donnan, Geoffrey A.; Fiebach, Jochen B.; Fiehler, Jens; Hacke, Werner; Lansberg, Maarten G.; Liebeskind, David S.; Mattle, Heinrich P.; Oppenheim, Catherine; Schellinger, Peter D.; Wardlaw, Joanna M.; Wintermark, Max.

In: International Journal of Stroke, Vol. 11, No. 2, 01.02.2016, p. 180-190.

Research output: Contribution to journalArticle

Luby, M, Warach, SJ, Albers, GW, Baron, JC, Cognard, C, Dávalos, A, Donnan, GA, Fiebach, JB, Fiehler, J, Hacke, W, Lansberg, MG, Liebeskind, DS, Mattle, HP, Oppenheim, C, Schellinger, PD, Wardlaw, JM & Wintermark, M 2016, 'Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making', International Journal of Stroke, vol. 11, no. 2, pp. 180-190. https://doi.org/10.1177/1747493015616634
Luby, Marie ; Warach, Steven J. ; Albers, Gregory W. ; Baron, Jean Claude ; Cognard, Christophe ; Dávalos, Antoni ; Donnan, Geoffrey A. ; Fiebach, Jochen B. ; Fiehler, Jens ; Hacke, Werner ; Lansberg, Maarten G. ; Liebeskind, David S. ; Mattle, Heinrich P. ; Oppenheim, Catherine ; Schellinger, Peter D. ; Wardlaw, Joanna M. ; Wintermark, Max. / Identification of imaging selection patterns in acute ischemic stroke patients and the influence on treatment and clinical trial enrollment decision making. In: International Journal of Stroke. 2016 ; Vol. 11, No. 2. pp. 180-190.
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