What stroke image do we want? European survey on acute stroke imaging and revascularisation treatment. Issue 3 (September 2019)

• Record Type: Journal Article
• Authors: Peultier, Anne-Claire; Redekop, William K.; Dippel, Diederik W.J.; Bereczki, Daniel; Si-Mohamed, Salim; Douek, Philippe C.; Severens, Johan L.
• Is Part Of: Health policy and technology. Volume 8:Issue 3(2019)
• Page Start: 261
• Page End: 267
• Publication Date: 2019-09
• Subjects: Stroke -- Imaging -- Revascularisation treatment -- Clinical practice variation -- Europe; ABN Association of British Neurologists -- ASPECTS Alberta Stroke Program Early CT score -- BASP British Association of Stroke Physicians -- CT computed tomography -- CTA computed tomography angiography -- DWI diffusion-weighted imaging -- ESO European Stroke Organisation -- ESNR European Society of Neuroradiology -- IA intra-arterial -- IV intravenous -- IVT intravenous thrombolysis -- MR magnetic resonance combined -- MRA magnetic resonance angiography -- MRI magnetic resonance imaging -- NRSG Neurosonology Research Group -- NIHSS National Institutes of Health Stroke Scale -- SPCCT spectral photon-counting computed tomography -- TIA transient ischemic attack; Medical policy -- Periodicals; Medical technology -- Periodicals; Medical policy; Medical technology; Health Policy -- Periodicals; Biomedical Technology -- Periodicals; Technology Assessment, Biomedical -- Periodicals; Periodicals; 362.105
• DOI: 10.1016/j.hlpt.2019.08.005
• Languages: English
• ISSNs: 2211-8837

Abstract

Highlights: CT and CTA remain the primary routine modalities of the comprehensive imaging workup in acute stroke care in Europe. The second line imaging test of the diagnostic workup in stroke care varies across European countries. Revascularisation treatments given to typical stroke patients vary considerably across European countries. The United Kingdom respondents reported particularly low rates of thrombectomy and high rates of intravenous thrombolysis compared to Sweden and Germany. A mismatch was identified between the preferred treatment and the treatment that Hungarian and UK-respondents actually administer to ischaemic stroke patients with large occlusion. Abstract: Introduction: The evolution of stroke treatment has been geared toward thrombolysis and thrombectomy, which requires quick imaging assessment. Various imaging and treatment options are available and current evidence suggests European differences in stroke care. We aimed to describe the patterns of stroke imaging and acute revascularisation therapy and examine variations across countries. Methods: A web-based clinician survey was developed and circulated to clinicians through email distribution lists and websites of European professional societies. Statistical analyses were performed. Results: We received responses from Sweden (21), the UK (16), Hungary (15), Germany (12) and Europe (47). Large variations are observed in revascularisation treatment: German respondents report that 81% of their ischaemic stroke patients diagnosed with a large vessel occlusion within 4.5 h receive intravenous thrombolysis and thrombectomy, compared to 12% reported by the UK-respondents. For patients diagnosed with an extensive ischaemic stroke within 2 h from onset, 75% of UK-respondents state thrombectomy as their preferred revascularisation treatment, but only 13% report to use it. Computed Tomography (CT) is reported as the most widely used first imaging test (for 81% to 93% of patients across geographic areas), while Magnetic Resonance Imaging (MRI) is a distant second. Conclusion: The diagnostic workup and, to a greater extent, the revascularisation treatments of typical stroke patients vary considerably across European countries. This study reinforces the need to compare the quality of stroke care in terms of process and outcomes between countries. Research is also needed to investigate the cost-effectiveness of second-line imaging strategies in acute stroke care.