title: Addition of hyperacute MRI AIDS in patient selection, decreasing the use of endovascular stroke therapy.
abstract: OBJECTIVE
  The failure of recent trials to show the effectiveness of acute endovascular stroke therapy (EST) may be because of inadequate patient selection. We implemented a protocol to perform pretreatment MRI on patients with large-vessel occlusion eligible for EST to aid in patient selection.
  
  
  METHODS
  We retrospectively identified patients with large-vessel occlusion considered for EST from January 2008 to August 2012. Patients before April 30, 2010, were selected based on computed tomography/computed tomography angiography (prehyperacute protocol), whereas patients on or after April 30, 2010, were selected based on computed tomography/computed tomography angiography and MRI (hyperacute MRI protocol). Demographic, clinical features, and outcomes were collected. Univariate and multivariate analyses were performed.
  
  
  RESULTS
  We identified 267 patients: 88 patients in prehyperacute MRI period and 179 in hyperacute MRI period. Fewer patients evaluated in the hyperacute MRI period received EST (85 of 88, 96.6% versus 92 of 179, 51.7%; P<0.05). The hyperacute-MRI group had a more favorable outcome of a modified Rankin scale 0 to 2 at 30 days as a group (6 of 66, 9.1% versus 33 of 140, 23.6%; P=0.01), and when taken for EST (6 of 63, 9.5% versus 17 of 71, 23.9%; P=0.03). On adjusted multivariate analysis, the EST in the hyperacute MRI period was associated with a more favorable outcome (odds ratio, 3.4; 95% confidence interval, 1.1-10.6; P=0.03) and reduced mortality rate (odds ratio, 0.16; 95% confidence interval, 0.03-0.37; P<0.001).
  
  
  CONCLUSIONS
  Implementation of hyperacute MRI protocol decreases the number of endovascular stroke interventions by half. Further investigation of MRI use for patient selection is warranted.
authors.affiliation: From the Cerebrovascular Center, Neurological Institute (D.W., K.U., J.G., S.A., P.G., C.R.N., S.M., J.M., M.W., E.C.-C., F.H., G.T., M.B., P.R., M.S.H.) and Imaging Institute (T.M., P.R.), Cleveland Clinic, OH; Division of Neurology, University of Alberta, Edmonton, Canada (M.S.); Department of Stroke Medicine, Kawasaki Medical School, Kurashiki, Japan (J.A.); and Cerebrovascular Center, Nagasaki University Hospital, Nagasaki City, Japan (Y.T.).
authors.forename: Dolora
authors.initials: D
authors.lastname: Wisco
authors.forename: Ken
authors.initials: K
authors.lastname: Uchino
authors.forename: Maher
authors.initials: M
authors.lastname: Saqqur
authors.forename: James M
authors.initials: JM
authors.lastname: Gebel
authors.forename: Junya
authors.initials: J
authors.lastname: Aoki
authors.forename: Shazia
authors.initials: S
authors.lastname: Alam
authors.forename: Pravin
authors.initials: P
authors.lastname: George
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Newey
authors.forename: Shumei
authors.initials: S
authors.lastname: Man
authors.forename: Yohei
authors.initials: Y
authors.lastname: Tateishi
authors.forename: Julie
authors.initials: J
authors.lastname: McNeil
authors.forename: Michelle
authors.initials: M
authors.lastname: Winfield
authors.forename: Esteban
authors.initials: E
authors.lastname: Cheng-Ching
authors.forename: Ferdinand K
authors.initials: FK
authors.lastname: Hui
authors.forename: Gabor
authors.initials: G
authors.lastname: Toth
authors.forename: Mark
authors.initials: M
authors.lastname: Bain
authors.forename: Peter A
authors.initials: PA
authors.lastname: Rasmussen
authors.forename: Thomas
authors.initials: T
authors.lastname: Masaryk
authors.forename: Paul
authors.initials: P
authors.lastname: Ruggieri
authors.forename: Muhammad Shazam
authors.initials: MS
authors.lastname: Hussain
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002533:Cerebral Angiography; D002544:Cerebral Infarction / Q000175:diagnosis; D002985:Clinical Protocols; D057510:Endovascular Procedures / Q000379:methods* / Q000706:statistics & numerical data*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007091:Image Processing, Computer-Assisted; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D018579:Patient Selection; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D020521:Stroke / Q000601:surgery*; D015912:Thrombolytic Therapy; D014057:Tomography, X-Ray Computed
keywords: cerebral revascularization; magnetic resonance imaging; stroke