title: Using a stroke database to develop an optimal vascular imaging protocol for ischemic stroke.
abstract: OBJECTIVE
  There are many combinations of studies for imaging the cervicocranial vasculature for diagnosis of ischemic stroke mechanism. We demonstrate a simple approach for using data from a stroke database to determine an optimal sequence of imaging studies on the basis of cost minimization and diagnostic yield.
  
  
  METHODS
  Our study uses patient data from the Hennepin County Medical Center stroke database, Minneapolis, Minn, to compare two vascular imaging protocols. In protocol 1, carotid ultrasound was the first vascular investigation for clinically determined anterior circulation strokes. Additional imaging with cervical and intracranial magnetic resonance angiography was obtained in nonanterior circulation cases and in cases when carotid ultrasound did not explain the mechanism for anterior circulation events. In protocol 2, cervical and intracranial magnetic resonance angiography was the first vascular investigation irrespective of the presumed topography of the stroke.
  
  
  RESULTS
  The mean cost per patient for imaging workup with protocol 1 was $702. With protocol 2, the cost was $679. Protocol 2 also provided clinically relevant information regarding tandem lesions and variations in intracranial collateral patterns that would have been missed by strictly following protocol 1.
  
  
  CONCLUSIONS
  Our results indicate that, given our hospital costs and patient population, obtaining a cervical and intracranial magnetic resonance angiogram after acute ischemic stroke leads to a lower average cost per patient than obtaining a carotid ultrasound first on presumed anterior circulation events. This result depends on the relative costs of imaging studies and could be different among hospitals serving different patient populations.
authors: Department of Neurology, University of Minnesota, Minneapolis, Minnesota 55455, USA. laksh004@umn.edu
authors: Kamakshi
authors: K
authors: Lakshminarayan
authors: David C
authors: DC
authors: Anderson
authors: Raymond A
authors: RA
authors: Gensinger