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Status of Acute Stroke Practice in Patients with a Cardiac Implantable Electronic Device
Yuji Kato1, Takeshi Hayashi1, Ritsushi Kato2
1Department of Neurology and Cerebrovascular Medicine, Saitama Medical University International Medical Center.
Insights
Patients with cardiac implantable electronic devices (CIED) experience delayed stroke diagnosis and undertreatment due to reliance on CT scans instead of MRI. This limits access to timely recanalization therapy for acute stroke.
Area of Science:
- Neurology
- Radiology
- Cardiology
Background:
- Magnetic resonance imaging (MRI) is crucial for acute stroke diagnosis and treatment in Japan.
- Patients with cardiac implantable electronic devices (CIED) cannot undergo MRI and rely on computed tomography (CT).
Purpose of the Study:
- To investigate the diagnostic accuracy of CT for acute stroke in CIED patients.
- To evaluate the impact of imaging limitations on recanalization therapy for acute stroke in CIED patients.
Main Methods:
- Retrospective analysis of clinical and neuroimaging data from 45 ischemic stroke patients with CIED.
- Comparison of lesion detection rates between initial CT scans and clinical outcomes.
- Evaluation of recanalization therapy decisions and consent processes.
Main Results:
- Delayed detection of acute stroke lesions was observed in CT scans compared to MRI.
- Inadequate information regarding MRI safety and efficacy led to non-consent for recanalization therapy in some cases.
- Patients with CIED experienced delayed diagnosis and undertreatment for acute stroke.
Conclusions:
- Computed tomography (CT) is less sensitive for detecting acute ischemic stroke lesions in patients with cardiac implantable electronic devices (CIED).
- Imaging limitations for CIED patients contribute to delayed treatment and undertreatment of acute stroke.
- Improved communication and alternative imaging strategies are needed for acute stroke management in CIED patients.
Abstract:
Although diagnostic and therapeutic strategies for acute stroke patients in Japan depend largely on magnetic resonance imaging (MRI), patients with cardiac implantable electronic devices (CIED) must still rely on com-puted tomography (CT). We retrospectively analyzed clinical and neuroimaging data of ischemic stroke patients with CIED treated at our hospital. Forty-five patients were enrolled in the study. Patients were divided into two groups according to whether corresponding lesions were detected (group A, n = 21) or not detected (group B, n = 24) by the first brain CT. We also evaluated in detail the clinical courses of patients who arrived at hospital within therapeutic time windows for recanalization therapy. Negative fresh infarct in the first CT was associated, though not significantly, with early onset-to-arrival time and subcortical white matter infarction. Five patients did not undergo recanalization therapy because their families did not agree to the procedure. The reasons for their lack of consent included inadequate information about the safety and efficacy of recanalization therapy because MRI could not be performed. Our study confirmed delayed detection of the corresponding lesion and undertreatment for acute stroke in patients with CIED.
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