International survey of acute Stroke imaging used to make revascularization treatment decisions

Max Wintermark, Marie Luby, Natan M. Bornstein, Andrew Demchuk, Jens Fiehler, Kohsuke Kudo, Kennedy R. Lees, David S. Liebeskind, Patrik Michel, Raul G. Nogueira, Mark W. Parsons, Makoto Sasaki, Joanna M. Wardlaw, Ona Wu, Weiwei Zhang, Guangming Zhu, Steven J. Warach

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

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: STroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (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 Australia, 101 from Europe, 4 from Middle East, 55 from North America, 13 from South America). In combination, the sites surveyed administered acute revascularization therapy to a total of 25326 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.

Original languageEnglish (US)
Pages (from-to)759-762
Number of pages4
JournalInternational Journal of Stroke
Volume10
Issue number5
DOIs
StatePublished - Jul 1 2015

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Stroke
Multimodal Imaging
Tissue Plasminogen Activator
Blood Vessels
Therapeutics
Perfusion Imaging
Middle East
South America
North America
Surveys and Questionnaires
Clinical Trials

Keywords

  • CT
  • MRI
  • Penumbra
  • Perfusion imaging
  • Stroke
  • Vascular imaging

ASJC Scopus subject areas

  • Neurology

Cite this

Wintermark, M., Luby, M., Bornstein, N. M., Demchuk, A., Fiehler, J., Kudo, K., ... Warach, S. J. (2015). International survey of acute Stroke imaging used to make revascularization treatment decisions. International Journal of Stroke, 10(5), 759-762. https://doi.org/10.1111/ijs.12491

International survey of acute Stroke imaging used to make revascularization treatment decisions. / 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.

In: International Journal of Stroke, Vol. 10, No. 5, 01.07.2015, p. 759-762.

Research output: Contribution to journalArticle

Wintermark, M, Luby, M, Bornstein, NM, Demchuk, A, Fiehler, J, Kudo, K, Lees, KR, Liebeskind, DS, Michel, P, Nogueira, RG, Parsons, MW, Sasaki, M, Wardlaw, JM, Wu, O, Zhang, W, Zhu, G & Warach, SJ 2015, 'International survey of acute Stroke imaging used to make revascularization treatment decisions', International Journal of Stroke, vol. 10, no. 5, pp. 759-762. https://doi.org/10.1111/ijs.12491
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. / International survey of acute Stroke imaging used to make revascularization treatment decisions. In: International Journal of Stroke. 2015 ; Vol. 10, No. 5. pp. 759-762.
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abstract = "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: STroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (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 Australia, 101 from Europe, 4 from Middle East, 55 from North America, 13 from South America). In combination, the sites surveyed administered acute revascularization therapy to a total of 25326 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.",
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AU - Luby, Marie

AU - Bornstein, Natan M.

AU - Demchuk, Andrew

AU - Fiehler, Jens

AU - Kudo, Kohsuke

AU - Lees, Kennedy R.

AU - Liebeskind, David S.

AU - Michel, Patrik

AU - Nogueira, Raul G.

AU - Parsons, Mark W.

AU - Sasaki, Makoto

AU - Wardlaw, Joanna M.

AU - Wu, Ona

AU - Zhang, Weiwei

AU - Zhu, Guangming

AU - Warach, Steven J.

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KW - Penumbra

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