Impact of MRI selection on triage of endovascular therapy in acute ischemic stroke

The MRI in acute management of ischemic stroke (MIAMIS) registry

Kunakorn Atchaneeyasakul, Ty Shang, Diogo Haussen, Gustavo Ortiz, Dileep R Yavagal

Research output: Contribution to journalArticle

Abstract

Background: The recently published multicenter randomized DAWN trial confirmed greater outcome benefit of endovascular therapy (ET) for anterior circulation large vessel occlusion ischemic stroke from 6 to 24 h from symptom onset compared to medical management in patients selected by advanced imaging with MRI or perfusion CT to identify mismatch between clinical deficit and infarct volume, which represents salvageable penumbra. The debate of CT over MRI is usually the potentially increase time consumption and the difficulty in establishing an adequate standardized workflow utilizing MRI during the hyperacute phase. Purpose: While CT-based selection of patients is the current standard of care, we sought to determine the time impact of the alternative approach of MRI selection in the 0-12 h window. Methods: In the MRI in Acute Management of Ischemic Stroke (MIAMIS) registry, we retrospectively analyzed 89 consecutive patients from January 2008 to January 2010 who presented with acute stroke symptoms with a National Institutes of Health Stroke Scale score ≥5 or aphasia within 0-12 h from symptom onset. The presence of penumbra was determined by MR perfusion-diffusion mismatch or clinical diffusion mismatch. Patients were stratified based on the presence of mismatch and clinical outcomes in patients who received ET. Imaging times were recorded. Results: The MRI turnaround time was 95.5 ± 48.5 min. The total MRI time was 27.7 ± 12.8 min. Seventeen (19.1%) patients were found to have nonvascular etiology. Mismatch was found in 35 (48.6%) patients with acute ischemic stroke (AIS). Patients with nonvascular etiology were younger (55.7 vs. 65.6 years, p < 0.02), without any vessel occlusion or mismatch noticed in this group. We dichotomized the 39 AIS patients with vessel occlusion into two subgroups: These with mismatch and these without. Patients without mismatch were older (76.7 vs. 64.4 years, p < 0.05), more likely to have congestive heart failure (71.4 vs. 22%, p < 0.03), a higher total serum cholesterol level (196 vs. 156 mg/dL, p < 0.04), and medium to large lesions on diffusion-weighted imaging (DWI) (85.7 vs. 37.5%, p < 0.04). Conclusions: Multimodality MRI screening for AIS symptoms for ET is feasible. Optimizing each center's protocol and the utilization of MRI with DWI only may be a time-saving alternative.

Original languageEnglish (US)
Pages (from-to)135-143
Number of pages9
JournalInterventional Neurology
DOIs
StatePublished - Jan 1 2019

Fingerprint

Triage
Registries
Stroke
Therapeutics
Perfusion
Diffusion Magnetic Resonance Imaging
Workflow
Aphasia
National Institutes of Health (U.S.)
Standard of Care
Patient Selection
Heart Failure
Cholesterol

Keywords

  • Acute ischemic stroke
  • Endovascular therapy
  • Mismatch
  • MRI

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Impact of MRI selection on triage of endovascular therapy in acute ischemic stroke : The MRI in acute management of ischemic stroke (MIAMIS) registry. / Atchaneeyasakul, Kunakorn; Shang, Ty; Haussen, Diogo; Ortiz, Gustavo; Yavagal, Dileep R.

In: Interventional Neurology, 01.01.2019, p. 135-143.

Research output: Contribution to journalArticle

@article{4e52d0dcd1a44c0d8bab2d66a2ca45c1,
title = "Impact of MRI selection on triage of endovascular therapy in acute ischemic stroke: The MRI in acute management of ischemic stroke (MIAMIS) registry",
abstract = "Background: The recently published multicenter randomized DAWN trial confirmed greater outcome benefit of endovascular therapy (ET) for anterior circulation large vessel occlusion ischemic stroke from 6 to 24 h from symptom onset compared to medical management in patients selected by advanced imaging with MRI or perfusion CT to identify mismatch between clinical deficit and infarct volume, which represents salvageable penumbra. The debate of CT over MRI is usually the potentially increase time consumption and the difficulty in establishing an adequate standardized workflow utilizing MRI during the hyperacute phase. Purpose: While CT-based selection of patients is the current standard of care, we sought to determine the time impact of the alternative approach of MRI selection in the 0-12 h window. Methods: In the MRI in Acute Management of Ischemic Stroke (MIAMIS) registry, we retrospectively analyzed 89 consecutive patients from January 2008 to January 2010 who presented with acute stroke symptoms with a National Institutes of Health Stroke Scale score ≥5 or aphasia within 0-12 h from symptom onset. The presence of penumbra was determined by MR perfusion-diffusion mismatch or clinical diffusion mismatch. Patients were stratified based on the presence of mismatch and clinical outcomes in patients who received ET. Imaging times were recorded. Results: The MRI turnaround time was 95.5 ± 48.5 min. The total MRI time was 27.7 ± 12.8 min. Seventeen (19.1{\%}) patients were found to have nonvascular etiology. Mismatch was found in 35 (48.6{\%}) patients with acute ischemic stroke (AIS). Patients with nonvascular etiology were younger (55.7 vs. 65.6 years, p < 0.02), without any vessel occlusion or mismatch noticed in this group. We dichotomized the 39 AIS patients with vessel occlusion into two subgroups: These with mismatch and these without. Patients without mismatch were older (76.7 vs. 64.4 years, p < 0.05), more likely to have congestive heart failure (71.4 vs. 22{\%}, p < 0.03), a higher total serum cholesterol level (196 vs. 156 mg/dL, p < 0.04), and medium to large lesions on diffusion-weighted imaging (DWI) (85.7 vs. 37.5{\%}, p < 0.04). Conclusions: Multimodality MRI screening for AIS symptoms for ET is feasible. Optimizing each center's protocol and the utilization of MRI with DWI only may be a time-saving alternative.",
keywords = "Acute ischemic stroke, Endovascular therapy, Mismatch, MRI",
author = "Kunakorn Atchaneeyasakul and Ty Shang and Diogo Haussen and Gustavo Ortiz and Yavagal, {Dileep R}",
year = "2019",
month = "1",
day = "1",
doi = "10.1159/000490580",
language = "English (US)",
pages = "135--143",
journal = "Interventional Neurology",
issn = "1664-9737",
publisher = "S. Karger AG",

}

TY - JOUR

T1 - Impact of MRI selection on triage of endovascular therapy in acute ischemic stroke

T2 - The MRI in acute management of ischemic stroke (MIAMIS) registry

AU - Atchaneeyasakul, Kunakorn

AU - Shang, Ty

AU - Haussen, Diogo

AU - Ortiz, Gustavo

AU - Yavagal, Dileep R

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: The recently published multicenter randomized DAWN trial confirmed greater outcome benefit of endovascular therapy (ET) for anterior circulation large vessel occlusion ischemic stroke from 6 to 24 h from symptom onset compared to medical management in patients selected by advanced imaging with MRI or perfusion CT to identify mismatch between clinical deficit and infarct volume, which represents salvageable penumbra. The debate of CT over MRI is usually the potentially increase time consumption and the difficulty in establishing an adequate standardized workflow utilizing MRI during the hyperacute phase. Purpose: While CT-based selection of patients is the current standard of care, we sought to determine the time impact of the alternative approach of MRI selection in the 0-12 h window. Methods: In the MRI in Acute Management of Ischemic Stroke (MIAMIS) registry, we retrospectively analyzed 89 consecutive patients from January 2008 to January 2010 who presented with acute stroke symptoms with a National Institutes of Health Stroke Scale score ≥5 or aphasia within 0-12 h from symptom onset. The presence of penumbra was determined by MR perfusion-diffusion mismatch or clinical diffusion mismatch. Patients were stratified based on the presence of mismatch and clinical outcomes in patients who received ET. Imaging times were recorded. Results: The MRI turnaround time was 95.5 ± 48.5 min. The total MRI time was 27.7 ± 12.8 min. Seventeen (19.1%) patients were found to have nonvascular etiology. Mismatch was found in 35 (48.6%) patients with acute ischemic stroke (AIS). Patients with nonvascular etiology were younger (55.7 vs. 65.6 years, p < 0.02), without any vessel occlusion or mismatch noticed in this group. We dichotomized the 39 AIS patients with vessel occlusion into two subgroups: These with mismatch and these without. Patients without mismatch were older (76.7 vs. 64.4 years, p < 0.05), more likely to have congestive heart failure (71.4 vs. 22%, p < 0.03), a higher total serum cholesterol level (196 vs. 156 mg/dL, p < 0.04), and medium to large lesions on diffusion-weighted imaging (DWI) (85.7 vs. 37.5%, p < 0.04). Conclusions: Multimodality MRI screening for AIS symptoms for ET is feasible. Optimizing each center's protocol and the utilization of MRI with DWI only may be a time-saving alternative.

AB - Background: The recently published multicenter randomized DAWN trial confirmed greater outcome benefit of endovascular therapy (ET) for anterior circulation large vessel occlusion ischemic stroke from 6 to 24 h from symptom onset compared to medical management in patients selected by advanced imaging with MRI or perfusion CT to identify mismatch between clinical deficit and infarct volume, which represents salvageable penumbra. The debate of CT over MRI is usually the potentially increase time consumption and the difficulty in establishing an adequate standardized workflow utilizing MRI during the hyperacute phase. Purpose: While CT-based selection of patients is the current standard of care, we sought to determine the time impact of the alternative approach of MRI selection in the 0-12 h window. Methods: In the MRI in Acute Management of Ischemic Stroke (MIAMIS) registry, we retrospectively analyzed 89 consecutive patients from January 2008 to January 2010 who presented with acute stroke symptoms with a National Institutes of Health Stroke Scale score ≥5 or aphasia within 0-12 h from symptom onset. The presence of penumbra was determined by MR perfusion-diffusion mismatch or clinical diffusion mismatch. Patients were stratified based on the presence of mismatch and clinical outcomes in patients who received ET. Imaging times were recorded. Results: The MRI turnaround time was 95.5 ± 48.5 min. The total MRI time was 27.7 ± 12.8 min. Seventeen (19.1%) patients were found to have nonvascular etiology. Mismatch was found in 35 (48.6%) patients with acute ischemic stroke (AIS). Patients with nonvascular etiology were younger (55.7 vs. 65.6 years, p < 0.02), without any vessel occlusion or mismatch noticed in this group. We dichotomized the 39 AIS patients with vessel occlusion into two subgroups: These with mismatch and these without. Patients without mismatch were older (76.7 vs. 64.4 years, p < 0.05), more likely to have congestive heart failure (71.4 vs. 22%, p < 0.03), a higher total serum cholesterol level (196 vs. 156 mg/dL, p < 0.04), and medium to large lesions on diffusion-weighted imaging (DWI) (85.7 vs. 37.5%, p < 0.04). Conclusions: Multimodality MRI screening for AIS symptoms for ET is feasible. Optimizing each center's protocol and the utilization of MRI with DWI only may be a time-saving alternative.

KW - Acute ischemic stroke

KW - Endovascular therapy

KW - Mismatch

KW - MRI

UR - http://www.scopus.com/inward/record.url?scp=85063317280&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85063317280&partnerID=8YFLogxK

U2 - 10.1159/000490580

DO - 10.1159/000490580

M3 - Article

SP - 135

EP - 143

JO - Interventional Neurology

JF - Interventional Neurology

SN - 1664-9737

ER -