Abstract Details

Title Utilization of Neuroimaging for Thrombolysis-Eligible Stroke Patients Presenting to Community and Academic Hospitals in a Large Urban Region

Topic Cerebrovascular Disease and Interventional Neurology

Presentation(s) P05 - (-)

Poster/Presentation
Number 234

Objective

Background BACKGROUND: Hyperacute stroke patients presenting in a time window of eligibility for thrombolysis (within 2 hours from onset) require urgent imaging, as well as follow-up imaging for confirmation of diagnosis.

Design/Methods DESIGN/METHODS: We reviewed consecutive patients enrolled in FAST-MAG, an NIH-funded phase 3 study of prehospital magnesium sulfate vs. placebo initiated within 2 hours from onset at 59 community and academic hospitals throughout Los Angeles and Orange Counties. Participating sites provide usual care to patients and there are no study imaging requirements.

Results RESULTS: There were 1304 consecutive cases of which 931 (72%) had a diagnosis of cerebral ischemia (242 clinical TIA, 688 Ischemic stroke), 318 (24%) intracranial hemorrhage and 54 (4%) stroke mimic. Initial imaging was CT in 1244 (95%, 42 included perfusion CT) and MRI in 60 (5%). The mean time from ED arrival to imaging was longer for acute MRI than CT (56 vs. 25 minutes, p=0.030). 642 of 931 (69%) patients with a final diagnosis of cerebral ischemia received MRI during admission of which 534 (83%) revealed a restricted diffusion lesion. The majority of MRI scans were not obtained urgently, at a mean (SD) 21.0 (20.9) and median (IQR) 18 (7-27) hours after ED arrival. Having a clinical syndrome lasting >24 hours was associated with a higher rate of positive diffusion on MRI (94% vs. 48%, p<0.0001). Of those who received perfusion CT, 26 (62%) were read as consistent with cerebral ischemia.

Conclusions CONCLUSIONS: In a sample of hospitals throughout Los Angeles and Orange Counties over 90% of acute stroke patients presenting within 2 hours of symptom onset received non-contrast CT as their initial imaging modality with approximately 5% utilizing perfusion CT and MRI.

Authors/Disclosures
Nerses Sanossian, MD, FAAN (Department of Neurology, USC) PRESENTER	Dr. Sanossian has received personal compensation for serving as an employee of Univeristy of Southern California. Dr. Sanossian has received personal compensation in the range of $10,000-$49,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Sanossian has received personal compensation in the range of $10,000-$49,999 for serving on a Speakers Bureau for Genentech. Dr. Sanossian has received personal compensation in the range of $5,000-$9,999 for serving on a Speakers Bureau for Portola. The institution of Dr. Sanossian has received research support from Diffusion Pharma.
Ugur Uygunoglu (Cerrahpasa)	Ugur Uygunoglu has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Roche Turkey . The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Novartis. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Biogen Idec/Gen Pharma of Turkey. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Merck-Serono of Turkey. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Sanovel of Turkey. The institution of Ugur Uygunoglu has received personal compensation in the range of $0-$499 for serving on a Scientific Advisory or Data Safety Monitoring board for Genveon of Turkey.
David S. Liebeskind, MD, FAAN (Neurovascular Imaging Research Core at UCLA)	Dr. Liebeskind has received research support from Cerenovus. Dr. Liebeskind has received research support from Genentech . Dr. Liebeskind has received research support from Medtronic. Dr. Liebeskind has received research support from Stryker.
Sidney Starkman, MD, FAAN (UCLA Emergency Medicine Center)	No disclosure on file
Scott Hamilton	No disclosure on file
	No disclosure on file
Jeffrey L. Saver, MD, FAAN (UCLA Health)	Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Medtronic. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Stryker. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Cerenovus. Dr. Saver has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Boehringer Ingelheim (prevention only). Dr. Saver has received personal compensation in the range of $10,000-$49,999 for serving as an Editor, Associate Editor, or Editorial Advisory Board Member for American Medical Association. Dr. Saver has received stock or an ownership interest from Rapid Medical.

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