Max Wintermark1, Marie Luby2,3, Natan M Bornstein4, Andrew Demchuk5, Jens Fiehler6, Kohsuke Kudo7, Kennedy R Lees8, David S Liebeskind9, Patrik Michel10, Raul G Nogueira11, Mark W Parsons12, Makoto Sasaki13, Joanna M Wardlaw14, Ona Wu15, Weiwei Zhang16, Guangming Zhu16, Steven J Warach3. 1. Department of Radiology, Neuroradiology, Stanford University, Palo Alto, CA, USA. 2. National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA. 3. Seton/UT Southwestern Clinical Research Institute of Austin, Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Austin, TX, USA. 4. Department of Neurology, Elias Sourasky Medical Centre, Sackler Faculty of Medicine, Tel-Aviv, Israel. 5. Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada. 6. Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 7. Department of Diagnostic Radiology, Hokkaido University Hospital, Sapporo, Japan. 8. University Department of Medicine & Therapeutics, Western Infirmary, University of Glasgow, Glasgow, UK. 9. Department of Neurology, UCLA Stroke Center, Los Angeles, CA, USA. 10. Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland. 11. Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA. 12. Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia. 13. Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan. 14. Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK. 15. Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA. 16. Department of Neurology, Military General Hospital of Beijing PLA, Beijing, China.
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 25,326 acute stroke patients in 2012. Seventy-three percent of these patients received intravenous (i.v.) 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.
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 25,326 acute strokepatients in 2012. Seventy-three percent of these patients received intravenous (i.v.) 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.
Authors: M Wintermark; P C Sanelli; G W Albers; J Bello; C Derdeyn; S W Hetts; M H Johnson; C Kidwell; M H Lev; D S Liebeskind; H Rowley; P W Schaefer; J L Sunshine; G Zaharchuk; C C Meltzer Journal: AJNR Am J Neuroradiol Date: 2013-08-01 Impact factor: 3.825
Authors: Werner Hacke; Anthony J Furlan; Yasir Al-Rawi; Antoni Davalos; Jochen B Fiebach; Franz Gruber; Markku Kaste; Leslie J Lipka; Salvador Pedraza; Peter A Ringleb; Howard A Rowley; Dietmar Schneider; Lee H Schwamm; Joaquin Serena Leal; Mariola Söhngen; Phil A Teal; Karin Wilhelm-Ogunbiyi; Max Wintermark; Steven Warach Journal: Lancet Neurol Date: 2008-12-25 Impact factor: 44.182
Authors: Edward C Jauch; Jeffrey L Saver; Harold P Adams; Askiel Bruno; J J Buddy Connors; Bart M Demaerschalk; Pooja Khatri; Paul W McMullan; Adnan I Qureshi; Kenneth Rosenfield; Phillip A Scott; Debbie R Summers; David Z Wang; Max Wintermark; Howard Yonas Journal: Stroke Date: 2013-01-31 Impact factor: 7.914
Authors: Chelsea S Kidwell; Reza Jahan; Jeffrey Gornbein; Jeffry R Alger; Val Nenov; Zahra Ajani; Lei Feng; Brett C Meyer; Scott Olson; Lee H Schwamm; Albert J Yoo; Randolph S Marshall; Philip M Meyers; Dileep R Yavagal; Max Wintermark; Judy Guzy; Sidney Starkman; Jeffrey L Saver Journal: N Engl J Med Date: 2013-02-08 Impact factor: 91.245
Authors: Max Wintermark; Gregory W Albers; Joseph P Broderick; Andrew M Demchuk; Jochen B Fiebach; Jens Fiehler; James C Grotta; Gary Houser; Tudor G Jovin; Kennedy R Lees; Michael H Lev; David S Liebeskind; Marie Luby; Keith W Muir; Mark W Parsons; Rüdiger von Kummer; Joanna M Wardlaw; Ona Wu; Albert J Yoo; Andrei V Alexandrov; Jeffry R Alger; Richard I Aviv; Roland Bammer; Jean-Claude Baron; Fernando Calamante; Bruce C V Campbell; Trevor C Carpenter; Søren Christensen; William A Copen; Colin P Derdeyn; E Clarke Haley; Pooja Khatri; Kohsuke Kudo; Maarten G Lansberg; Lawrence L Latour; Ting-Yim Lee; Richard Leigh; Weili Lin; Patrick Lyden; Grant Mair; Bijoy K Menon; Patrik Michel; Robert Mikulik; Raul G Nogueira; Leif Ostergaard; Salvador Pedraza; Christian H Riedel; Howard A Rowley; Pina C Sanelli; Makoto Sasaki; Jeffrey L Saver; Pamela W Schaefer; Peter D Schellinger; Georgios Tsivgoulis; Lawrence R Wechsler; Philip M White; Greg Zaharchuk; Osama O Zaidat; Stephen M Davis; Geoffrey A Donnan; Anthony J Furlan; Werner Hacke; Dong-Wha Kang; Chelsea Kidwell; Vincent N Thijs; Götz Thomalla; Steven J Warach Journal: Stroke Date: 2013-07-16 Impact factor: 7.914
Authors: Puck S S Fransen; Debbie Beumer; Olvert A Berkhemer; Lucie A van den Berg; Hester Lingsma; Aad van der Lugt; Wim H van Zwam; Robert J van Oostenbrugge; Yvo B W E M Roos; Charles B Majoie; Diederik W J Dippel Journal: Trials Date: 2014-09-01 Impact factor: 2.279
Authors: Antonio Granato; Laura D'Acunto; Miloš Ajčević; Giovanni Furlanis; Maja Ukmar; Roberta Antea Pozzi Mucelli; Paolo Manganotti Journal: Neurol Sci Date: 2020-05-26 Impact factor: 3.307
Authors: F Kauw; V Y Ding; J W Dankbaar; F van Ommen; G Zhu; D B Boothroyd; D N Wolman; L Molvin; H W A M de Jong; L J Kappelle; B K Velthuis; J J Heit; M Wintermark Journal: AJNR Am J Neuroradiol Date: 2022-08-11 Impact factor: 4.966
Authors: Søren Christensen; Shalini Amukotuwa; Maarten G Lansberg; Stephanie Kemp; Jeremy J Heit; Michael Mlynash; Michael P Marks; Greg W Albers; Roland Bammer Journal: J Cereb Blood Flow Metab Date: 2020-03-24 Impact factor: 6.960
Authors: Marie Dagonnier; Ira Robin Cooke; Pierre Faou; Tara Kate Sidon; Helen Margaret Dewey; Geoffrey Alan Donnan; David William Howells Journal: Biomark Insights Date: 2017-12-20
Authors: Grant Mair; Awad Alzahrani; Richard I Lindley; Peter A G Sandercock; Joanna M Wardlaw Journal: Neuroradiology Date: 2020-10-30 Impact factor: 2.804
Authors: Jan W Dankbaar; Kelly G P Kerckhoffs; Alexander D Horsch; Irene C van der Schaaf; L Jaap Kappelle; Birgitta K Velthuis Journal: Clin Neuroradiol Date: 2017-04-24 Impact factor: 3.649