Detection of intracranial atherosclerosis: which imaging techniques are available in European hospitals?

The diagnosis of intracranial atherosclerosis requires availability of appropriate imaging techniques. The objective was to evaluate the proportion of European hospitals where imaging techniques necessary to detect intracranial atherosclerosis are available. Method- We randomly selected 886 hospitals in 25 countries and classified them in 3 categories according to the availability of 3 imaging techniques (transcranial color-coded duplex imaging, computed tomographic angiography, and magnetic resonance angiography): "all" when the 3 techniques were available, "at least 1," and "none." We compared the proportion of hospitals meeting these criteria, using the odds ratio method and Germany as reference.

Two hundred seventy-two hospitals (30.7%) met criteria for all, 445 (50.2%) met criteria for at least 1, and 169 (19.1%) met criteria for none. In 2005, they had admitted, respectively, 139,118, 160, 393, and 62 667 stroke patients. Brain CT or MRI were available in 820 (92.6%) hospitals, computed tomographic angiography in 619 (69.9%), magnetic resonance angiography in 498 (56.2%), and transcranial color-coded duplex in 352 (39.7%). Compared to Germany, Greece (OR, 0.11; 95% CI, 0.01-0.88), Iberic countries (OR, 0.11; 95% CI, 0.05-0.27), Baltic countries (OR, 0.13; 95% CI, 0.03-0.56), Poland (OR, 0.40; 95% CI, 0.21-0.77), and France (OR, 0.52; 95% CI, 0.31-0.89), had significantly less hospitals in the all group.

In Europe, less than one-third of ischemic stroke patients are admitted in hospitals with all imaging techniques available to detect intracranial atherosclerosis. There are important differences between countries.