Addition of hyperacute MRI AIDS in patient selection, decreasing the use of endovascular stroke therapy

Stroke. 2014 Feb;45(2):467-72. doi: 10.1161/STROKEAHA.113.003880. Epub 2014 Jan 9.

Abstract

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.

Keywords: cerebral revascularization; magnetic resonance imaging; stroke.

MeSH terms

  • Aged
  • Analysis of Variance
  • Cerebral Angiography
  • Cerebral Infarction / diagnosis
  • Clinical Protocols
  • Endovascular Procedures / methods*
  • Endovascular Procedures / statistics & numerical data*
  • Female
  • Follow-Up Studies
  • Humans
  • Image Processing, Computer-Assisted
  • Logistic Models
  • Magnetic Resonance Imaging / methods*
  • Male
  • Patient Selection*
  • Retrospective Studies
  • Risk Factors
  • Stents
  • Stroke / surgery*
  • Thrombolytic Therapy
  • Tomography, X-Ray Computed