MRI as a first-line imaging modality in acute ischemic stroke: a sustainable concept

Abstract

Background: Computed tomography (CT) scans are the first-line imaging technique in acute stroke patients based on the argument of rapid feasibility. Using magnetic resonance imaging (MRI) as the first-line imaging technique is the exception to the rule, although it provides much more diagnostic information and avoids exposure to radiation. We evaluated whether an MRI-based acute stroke concept is fast, suitable, and useful to improve recanalization rates and patient outcomes. Methods: We performed a retrospective observational cohort study comparing patients treated at a comprehensive stroke center (Ulm/Germany) applying an MRI-based acute stroke concept with patients recorded in a large comprehensive stroke registry in Baden-Württemberg (Germany). We analyzed the quality indicators of acute stroke treatment, patient’s outcome, and the rate of transient ischemic attack (TIA) at discharge. Results: A total of 2182 patients from Ulm and 82,760 patients from the Baden-Württemberg (BW) stroke registry (including 29,575 patients of comprehensive stroke centers (BWc)) were included. Intravenous thrombolysis rate was higher in Ulm than in BW or the BWc stroke centers (Ulm 27.4% versus BW 20.9% versus BWc 26.1; p < 0.01), while a door-to-needle time <30 min could be achieved more frequently (Ulm 73.6% versus BW 44.1% versus BWc 47.1%; p < 0.01). Thrombectomy rate in patients with a proximal vascular occlusion was higher (Ulm 69.2% versus BW 50.7% versus BWc 59.3; p < 0.01). The number of TIA diagnoses was lower (Ulm 16.2% versus BW 24.6% versus BWc 19.9%; p < 0.01). More patients showed a shift to a favorable outcome (Ulm 21.1% versus BW 16.9% versus BWc 15.3; p < 0.01). Complication rates were similar. Conclusions: The MRI-based acute stroke concept is suitable, fast and seems to be beneficial. The time-dependent quality indicators were better both in comparison to all stroke units and to the comprehensive stroke units in the area. Based on the MRI concept, high rates of recanalization procedures and fewer TIA diagnoses could be observed. In addition, there was a clear trend towards an improved clinical outcome. A clinical trial comparing the effects of CT and MRI as the primary imaging technique in otherwise identical stroke unit settings is warranted.

HARM revisited: Etiology of subarachnoid hyperintensities in brain FLAIR MRI

“…The high rates of CVD patients (57%) could be overestimated in our sample, as MRI with GBCA dependent perfusion weighted imaging is our first line imaging for stroke patients. 20 Our data neither support a close association of stroke-related HARM and recanalizing therapies (since only half of the ischemic stroke patients with HARM had received recanalizing therapies before occurrence of HARM) nor with administration of GBCA (only 64% of HARM patients).…”

Andexanet Alfa for Reversal of Factor Xa Inhibitors in Intracranial Hemorrhage: Observational Cohort Study

“…AA was dosed according to the product labeling for life-threatening bleeding associated with FXa-inhibitors with a bolus, followed by a 2-h infusion [ 21 ]. All patients were treated in our stroke unit according to the national guidelines.…”

Thrombolysis in central retinal artery occlusion: a retrospective observational study

“…At first the patients were examined by an ophthalmologist who diagnosed the CRAO. Second, the patients were referred to the neurology department and a standard stroke workup including laboratory tests and cerebral magnetic resonance imaging (MRI) was performed [ 17 ]. A-CRAO was ruled out clinically and by laboratory diagnostics (erythrocyte sedimentation rate and C-reactive protein).…”