Pretreatment advanced imaging in patients with stroke treated with IV thrombolysis: Evaluation of a multihospital data base

Jennifer S McDonald, J. Fan, David F Kallmes, H. J. Cloft

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Abstract

BACKGROUND AND PURPOSE: CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis. MATERIALS AND METHODS: Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging. RESULTS: Of 12,429 included patients, 7305 (59%) were in the CT group, 2359 (19%) were in the CTA group, 848 (7%) were in the CTP group, and 1917 (15%) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64% to 55%, while the percentage who received cerebral CT perfusion increased from 3% to 8%. The use of CT angiography and MR imaging marginally increased (1%-2%). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95% CI, 0.96 -1.43]; P = .0412) and MR group (OR = 1.14 [95% CI, 1.01-1.28]; P = .0177) and mortality was lower in the MR group (OR = 0.64 [95% CI, 0.52- 0.79]; P < .0001). CONCLUSIONS: Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear.

Original languageEnglish (US)
Pages (from-to)478-481
Number of pages4
JournalAmerican Journal of Neuroradiology
Volume35
Issue number3
DOIs
StatePublished - 2014

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Stroke
Databases
Cytidine Triphosphate
Perfusion
Long-Term Care
Head
Perfusion Imaging
Mortality
Patient Discharge
Thrombolytic Therapy
Logistic Models
Computed Tomography Angiography
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology
  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

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title = "Pretreatment advanced imaging in patients with stroke treated with IV thrombolysis: Evaluation of a multihospital data base",
abstract = "BACKGROUND AND PURPOSE: CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis. MATERIALS AND METHODS: Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging. RESULTS: Of 12,429 included patients, 7305 (59{\%}) were in the CT group, 2359 (19{\%}) were in the CTA group, 848 (7{\%}) were in the CTP group, and 1917 (15{\%}) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64{\%} to 55{\%}, while the percentage who received cerebral CT perfusion increased from 3{\%} to 8{\%}. The use of CT angiography and MR imaging marginally increased (1{\%}-2{\%}). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95{\%} CI, 0.96 -1.43]; P = .0412) and MR group (OR = 1.14 [95{\%} CI, 1.01-1.28]; P = .0177) and mortality was lower in the MR group (OR = 0.64 [95{\%} CI, 0.52- 0.79]; P < .0001). CONCLUSIONS: Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear.",
author = "McDonald, {Jennifer S} and J. Fan and Kallmes, {David F} and Cloft, {H. J.}",
year = "2014",
doi = "10.3174/ajnr.A3797",
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TY - JOUR

T1 - Pretreatment advanced imaging in patients with stroke treated with IV thrombolysis

T2 - Evaluation of a multihospital data base

AU - McDonald, Jennifer S

AU - Fan, J.

AU - Kallmes, David F

AU - Cloft, H. J.

PY - 2014

Y1 - 2014

N2 - BACKGROUND AND PURPOSE: CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis. MATERIALS AND METHODS: Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging. RESULTS: Of 12,429 included patients, 7305 (59%) were in the CT group, 2359 (19%) were in the CTA group, 848 (7%) were in the CTP group, and 1917 (15%) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64% to 55%, while the percentage who received cerebral CT perfusion increased from 3% to 8%. The use of CT angiography and MR imaging marginally increased (1%-2%). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95% CI, 0.96 -1.43]; P = .0412) and MR group (OR = 1.14 [95% CI, 1.01-1.28]; P = .0177) and mortality was lower in the MR group (OR = 0.64 [95% CI, 0.52- 0.79]; P < .0001). CONCLUSIONS: Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear.

AB - BACKGROUND AND PURPOSE: CT angiography, CT perfusion, and MR imaging have all been advocated as potentially useful in treatment planning for patients with acute ischemic stroke. We evaluated a large multihospital data base to determine how the use of advanced imaging is evolving in patients treated with intravenous thrombolysis. MATERIALS AND METHODS: Patients with acute ischemic stroke receiving IV thrombolytic therapy from 2008 to 2011 were identified by using the Premier Perspective data base. Mortality and discharge to long-term care rates were compared following multivariate logistic regression between patients who received head CT only versus those who received CTA without CT perfusion, CT perfusion, or MR imaging. RESULTS: Of 12,429 included patients, 7305 (59%) were in the CT group, 2359 (19%) were in the CTA group, 848 (7%) were in the CTP group, and 1917 (15%) were in the MR group. From 2008 to 2011, the percentage of patients receiving head CT only decreased from 64% to 55%, while the percentage who received cerebral CT perfusion increased from 3% to 8%. The use of CT angiography and MR imaging marginally increased (1%-2%). Outcomes were similar between CT only and advanced imaging patients, except discharge to long-term care was slightly more frequent in the CTP group (OR = 1.17 [95% CI, 0.96 -1.43]; P = .0412) and MR group (OR = 1.14 [95% CI, 1.01-1.28]; P = .0177) and mortality was lower in the MR group (OR = 0.64 [95% CI, 0.52- 0.79]; P < .0001). CONCLUSIONS: Use of advanced imaging is increasing in patients treated with IV thrombolysis. While there were differences in outcomes among imaging groups, the clinical effect of advanced imaging remains unclear.

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