TY - JOUR
T1 - Addition of hyperacute MRI aids in patient selection, decreasing the use of endovascular stroke therapy
AU - Wisco, Dolora
AU - Uchino, Ken
AU - Saqqur, Maher
AU - Gebel, James M.
AU - Aoki, Junya
AU - Alam, Shazia
AU - George, Pravin
AU - Newey, Christopher R.
AU - Man, Shumei
AU - Tateishi, Yohei
AU - McNeil, Julie
AU - Winfield, Michelle
AU - Cheng-Ching, Esteban
AU - Hui, Ferdinand K.
AU - Toth, Gabor
AU - Bain, Mark
AU - Rasmussen, Peter A.
AU - Masaryk, Thomas
AU - Ruggieri, Paul
AU - Hussain, Muhammad Shazam
PY - 2014/2
Y1 - 2014/2
N2 - Background and Purpose - The failure of recent trials to show the effectiveness of acute endovascular stroke therapy (EST) may be because of inadequate patient selection. We implemented a protocol to perform pretreatment MRI on patients with large-vessel occlusion eligible for EST to aid in patient selection. Methods - We retrospectively identified patients with large-vessel occlusion considered for EST from January 2008 to August 2012. Patients before April 30, 2010, were selected based on computed tomography/computed tomography angiography (prehyperacute protocol), whereas patients on or after April 30, 2010, were selected based on computed tomography/computed tomography angiography and MRI (hyperacute MRI protocol). Demographic, clinical features, and outcomes were collected. Univariate and multivariate analyses were performed. Results - We identified 267 patients: 88 patients in prehyperacute MRI period and 179 in hyperacute MRI period. Fewer patients evaluated in the hyperacute MRI period received EST (85 of 88, 96.6% versus 92 of 179, 51.7%; P<0.05). The hyperacute-MRI group had a more favorable outcome of a modified Rankin scale 0 to 2 at 30 days as a group (6 of 66, 9.1% versus 33 of 140, 23.6%; P=0.01), and when taken for EST (6 of 63, 9.5% versus 17 of 71, 23.9%; P=0.03). On adjusted multivariate analysis, the EST in the hyperacute MRI period was associated with a more favorable outcome (odds ratio, 3.4; 95% confidence interval, 1.1-10.6; P=0.03) and reduced mortality rate (odds ratio, 0.16; 95% confidence interval, 0.03-0.37; P<0.001). Conclusions - Implementation of hyperacute MRI protocol decreases the number of endovascular stroke interventions by half. Further investigation of MRI use for patient selection is warranted.
AB - Background and Purpose - The failure of recent trials to show the effectiveness of acute endovascular stroke therapy (EST) may be because of inadequate patient selection. We implemented a protocol to perform pretreatment MRI on patients with large-vessel occlusion eligible for EST to aid in patient selection. Methods - We retrospectively identified patients with large-vessel occlusion considered for EST from January 2008 to August 2012. Patients before April 30, 2010, were selected based on computed tomography/computed tomography angiography (prehyperacute protocol), whereas patients on or after April 30, 2010, were selected based on computed tomography/computed tomography angiography and MRI (hyperacute MRI protocol). Demographic, clinical features, and outcomes were collected. Univariate and multivariate analyses were performed. Results - We identified 267 patients: 88 patients in prehyperacute MRI period and 179 in hyperacute MRI period. Fewer patients evaluated in the hyperacute MRI period received EST (85 of 88, 96.6% versus 92 of 179, 51.7%; P<0.05). The hyperacute-MRI group had a more favorable outcome of a modified Rankin scale 0 to 2 at 30 days as a group (6 of 66, 9.1% versus 33 of 140, 23.6%; P=0.01), and when taken for EST (6 of 63, 9.5% versus 17 of 71, 23.9%; P=0.03). On adjusted multivariate analysis, the EST in the hyperacute MRI period was associated with a more favorable outcome (odds ratio, 3.4; 95% confidence interval, 1.1-10.6; P=0.03) and reduced mortality rate (odds ratio, 0.16; 95% confidence interval, 0.03-0.37; P<0.001). Conclusions - Implementation of hyperacute MRI protocol decreases the number of endovascular stroke interventions by half. Further investigation of MRI use for patient selection is warranted.
KW - Cerebral revascularization
KW - Magnetic resonance imaging
KW - Stroke
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UR - http://www.scopus.com/inward/citedby.url?scp=84893742576&partnerID=8YFLogxK
U2 - 10.1161/STROKEAHA.113.003880
DO - 10.1161/STROKEAHA.113.003880
M3 - Article
C2 - 24407952
AN - SCOPUS:84893742576
VL - 45
SP - 467
EP - 472
JO - Stroke
JF - Stroke
SN - 0039-2499
IS - 2
ER -