A Multicenter Survey of Acute Stroke Imaging Protocols for Endovascular Thrombectomy

Identifying current practices in acute stroke imaging is essential for establishing optimal imaging protocols. We surveyed and assessed the current status of acute stroke imaging for endovascular thrombectomy (EVT) at tertiary hospitals throughout South Korea.

An electronic questionnaire on imaging protocols for EVT in patients with acute ischemic stroke was e-mailed to physicians at 42 registered tertiary hospitals, and their responses were collected between February and March 2020.

Of the 36 hospitals participating in the survey, 69% (25/36) adopted computed tomography (CT)-based protocols, whereas 31% (11/36) adopted magnetic resonance (MR)-based protocols. Non-enhanced CT (NECT) was the initial imaging study at 28%, NECT with CT angiography (CTA) at 36%, and NECT with CTA and CT perfusion (CTP) at 33% of hospitals. Perfusion imaging was performed at 61% (22/36), CTP at 44% (16/36), and MR perfusion at 17% (6/36) of hospitals. Multiphase CTA was performed at 67%, single-phase CTA at 11%, time-of-flight MR angiography (MRA) at 8%, contrast-enhanced MRA at 8%, and both at 6% of hospitals. For late time window stroke, 50% of hospitals used identical imaging protocols to those for early time window stroke, 39% used additional MR imaging (MRI), and 6% converted the imaging strategy from CT to MRI. Post-processing programs were used at 28% (10/36), and RAPID software at 14% (5/36) of hospitals, respectively. Most hospitals (92%) used the same imaging protocols for posterior and anterior circulation strokes.

Our multicenter survey demonstrated considerable heterogeneity in acute stroke imaging protocols across South Korean tertiary hospitals, suggesting that hospitals refine their imaging protocols according to hospital-specific conditions.