title: International survey of acute stroke imaging used to make revascularization treatment decisions.
abstract: BACKGROUND
  To assess the differences across continental regions in terms of stroke imaging obtained for making acute revascularization therapy decisions, and to identify obstacles to participating in randomized trials involving multimodal imaging.
  
  
  METHODS
  STroke Imaging Repository (STIR) and Virtual International Stroke Trials Archive (VISTA)-Imaging circulated an online survey through its website, through the websites of national professional societies from multiple countries as well as through email distribution lists from STIR and the above mentioned societies.
  
  
  RESULTS
  We received responses from 223 centers (2 from Africa, 38 from Asia, 10 from Australia, 101 from Europe, 4 from Middle East, 55 from North America, 13 from South America). In combination, the sites surveyed administered acute revascularization therapy to a total of 25,326 acute stroke patients in 2012. Seventy-three percent of these patients received intravenous (i.v.) tissue plasminogen activator (tPA), and 27%, endovascular therapy. Vascular imaging was routinely obtained in 79% (152/193) of sites for endovascular therapy decisions, and also as part of standard IV tPA treatment decisions at 46% (92/198) of sites. Modality, availability and use of acute vascular and perfusion imaging before revascularization varied substantially between geographical areas. The main obstacles to participate in randomized trials involving multimodal imaging included: mainly insufficient research support and staff (50%, 79/158) and infrequent use of multimodal imaging (27%, 43/158) .
  
  
  CONCLUSIONS
  There were significant variations among sites and geographical areas in terms of stroke imaging work-up used tomake decisions both for intravenous and endovascular revascularization. Clinical trials using advanced imaging as a selection tool for acute revascularization therapy should address the need for additional resources and technical support, and take into consideration the lack of routine use of such techniques in trial planning.
authors.affiliation: Department of Radiology, Neuroradiology, Stanford University, Palo Alto, CA, USA.
authors.forename: Max
authors.initials: M
authors.lastname: Wintermark
authors.affiliation: National Institute of Neurological Disorders and Stroke (NINDS), National Institutes of Health (NIH), Bethesda, MD, USA.|Seton/UT Southwestern Clinical Research Institute of Austin, Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Austin, TX, USA.
authors.forename: Marie
authors.initials: M
authors.lastname: Luby
authors.affiliation: Department of Neurology, Elias Sourasky Medical Centre, Sackler Faculty of Medicine, Tel-Aviv, Israel.
authors.forename: Natan M
authors.initials: NM
authors.lastname: Bornstein
authors.affiliation: Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada.
authors.forename: Andrew
authors.initials: A
authors.lastname: Demchuk
authors.affiliation: Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Fiehler
authors.affiliation: Department of Diagnostic Radiology, Hokkaido University Hospital, Sapporo, Japan.
authors.forename: Kohsuke
authors.initials: K
authors.lastname: Kudo
authors.affiliation: University Department of Medicine & Therapeutics, Western Infirmary, University of Glasgow, Glasgow, UK.
authors.forename: Kennedy R
authors.initials: KR
authors.lastname: Lees
authors.affiliation: Department of Neurology, UCLA Stroke Center, Los Angeles, CA, USA.
authors.forename: David S
authors.initials: DS
authors.lastname: Liebeskind
authors.affiliation: Centre Hospitalier Universitaire Vaudois (CHUV), University of Lausanne, Lausanne, Switzerland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.affiliation: Marcus Stroke & Neuroscience Center/Grady Memorial Hospital, Emory University School of Medicine, Atlanta, GA, USA.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
authors.affiliation: Department of Neurology, John Hunter Hospital, Hunter Medical Research Institute, University of Newcastle, Newcastle, NSW, Australia.
authors.forename: Mark W
authors.initials: MW
authors.lastname: Parsons
authors.affiliation: Institute for Biomedical Sciences, Iwate Medical University, Yahaba, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Sasaki
authors.affiliation: Brain Research Imaging Centre, Division of Neuroimaging Sciences, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.
authors.forename: Joanna M
authors.initials: JM
authors.lastname: Wardlaw
authors.affiliation: Martinos Center for Biomedical Imaging, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA.
authors.forename: Ona
authors.initials: O
authors.lastname: Wu
authors.affiliation: Department of Neurology, Military General Hospital of Beijing PLA, Beijing, China.
authors.forename: Weiwei
authors.initials: W
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Military General Hospital of Beijing PLA, Beijing, China.
authors.forename: Guangming
authors.initials: G
authors.lastname: Zhu
authors.affiliation: Seton/UT Southwestern Clinical Research Institute of Austin, Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Austin, TX, USA.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Warach
mesh_terms: D003657:Decision Making; D003952:Diagnostic Imaging; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007391:International Cooperation; D008297:Male; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000175:diagnosis* / Q000628:therapy*; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000379:methods*; D013997:Time Factors
keywords: CT; MRI; penumbra; perfusion imaging; stroke; vascular imaging
references.citation: N Engl J Med. 2013 Mar 7;368(10 ):914-23
references.pmid: 23394476
references.citation: J Stroke Cerebrovasc Dis. 2012 Feb;21(2):131-42
references.pmid: 20719541
references.citation: Lancet Neurol. 2009 Feb;8(2):141-50
references.pmid: 19097942
references.citation: Trials. 2014 Sep 01;15:343
references.pmid: 25179366
references.citation: Stroke. 2013 Sep;44(9):2628-39
references.pmid: 23860298
references.citation: Stroke. 2013 Mar;44(3):870-947
references.pmid: 23370205
references.citation: AJNR Am J Neuroradiol. 2013 Nov-Dec;34(11):E117-27
references.pmid: 23907247