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Optimized Management of Endovascular Treatment for Acute Ischemic Stroke

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Criteria for Emergency Brain MRI During Stroke-Alert.

Evgeny Sidorov¹, Courtney Iser², Nidhi Kapoor³

¹Department of Neurology, University of Oklahoma Health Sciences Center, 920 S.L.Young Blvd #2040, Oklahoma City, OK 73104, USA; Oklahoma Center for Neuroscience, University of Oklahoma Health Sciences Center, 1100 N Lindsay Ave., Oklahoma City, OK 73104, USA.

Journal of Stroke and Cerebrovascular Diseases : the Official Journal of National Stroke Association

|June 9, 2021

Summary

This summary is machine-generated.

New criteria for emergency brain MRI in stroke alerts help identify stroke mimics, improving accuracy in administering IV tPA to acute ischemic stroke patients. This selective imaging approach enhances diagnostic decision-making.

Keywords:

Emergency MRI IV tPA MRI indication Stroke mimics Stroke-alert

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Area of Science:

Neurology
Emergency Medicine
Radiology

Background:

Intravenous (IV) tissue plasminogen activator (tPA) is crucial for acute ischemic stroke (AIS) but contraindicated in stroke mimics (SM).
Selective use of emergency brain magnetic resonance imaging (eMRI-brain) can aid diagnosis in stroke alerts.
Currently, accepted utilization criteria for eMRI-brain in this context are lacking.

Purpose of the Study:

To develop and validate history-based criteria for performing eMRI-brain during stroke alerts.
To assess the diagnostic yield of eMRI-brain in differentiating AIS from SM.
To evaluate the impact of selective eMRI-brain on IV tPA administration decisions.

Main Methods:

Developed three history-based criteria for eMRI-brain: prior similar deficits, altered consciousness at onset, and migraine aura-like symptoms.
Conducted a 5-year retrospective chart review of stroke-alert patients.
Analyzed the effect of these criteria on IV tPA administration for AIS and SM.

Main Results:

Of 3,512 stroke alerts, 230 (8.1%) met eMRI-brain criteria, with 92.6% identified as SM and 7.4% as AIS.
eMRI-brain use led to less frequent IV tPA administration in SM (PCC=0.841, p=0.036) and fewer failures to administer tPA in AIS (PCC=-0.907, p=0.013).
No delays in IV tPA eligibility were attributed to MRI procedures.

Conclusions:

History-based criteria for selective eMRI-brain in stroke alerts demonstrate a high yield for identifying stroke mimics.
Targeted eMRI-brain utilization enhances the accuracy of IV tPA administration decisions.
This approach optimizes treatment for acute stroke patients while avoiding unnecessary thrombolysis in mimics.