Stroke

Cardiovascular departments are playing a role in stroke interventions at numerous health systems, working as part of the stroke care team with neurologists, radiology and the emergency department. Stroke first has be be classified as ischemic or hemorrhagic. These have very different care pathways. Ischemic strokes are increasingly being treated with neurological-interventional therapy that includes catheter based mechanical thrombectomy to remove the clot. This is a more aggressive treatment compared to traditional IV administration of tissue plasminogen activator (tPA) thrombolytic therapy to dissolve the clot. Subarachnoid hemorrhage (SAH) and  intracerebral hemorrhage (ICH) brain bleeds can also be treated in some cases stent flow diverters and embolization coils. 

Some neurovascular imaging studies are overutilized in stroke triage

Triaging patients with stroke-like symptoms using MRI with diffusion-weighted imaging (DWI) could reduce the cost burden associated with unnecessary neurovascular imaging procedures. 

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'One-stop-shop' CT protocol saves time, reduces radiation needed for acute stroke imaging

The protocol does not come at the expense of deteriorated image quality, according to work published recently in the European Journal of Radiology.

Expansion of open-source neuroimaging dataset aims to boost stroke research

Researchers recently revamped the database in the hopes of expanding algorithm development in the field of stroke care. 

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70% of ‘mini-stroke’ patients imaged incompletely, risking full-on stroke

Emergency patients diagnosed with transient ischemic attack are supposed to receive, per multiple society guidelines, a complete imaging workup as soon as possible—preferably within 48 hours of ED discharge.

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New bleeding stroke guidelines highlight several common treatments that may be ineffective

The updated document, developed by the American Heart Association and American Stroke Association, also emphasizes the potential benefits of caregiver training and MR imaging. 

Ischemic stroke CT imaging. Images courtesy of RSNA

Stroke care still lags among certain Medicare populations

Despite increases of 250% for CTA and 428% for CTP, researchers observed lower rates of neuroimaging utilization among rural residents, older individuals (80 years and above), women and Black patients.

Ischemic stroke CT scan showing color coded blood flow for early and later arterial and venous contrast phases and areas of blocked blood flow. Image courtesy of RSNA

Disparities evident as CT stroke imaging rises sharply over 7-year period

Utilization of head CT perfusion (CTP) for imaging stroke patients spiked 428% between 2012 and 2019. Curiously, the uptrend was associated with higher mortality up to a year after discharge.

FDA warns providers about potential misuse of imaging-based software for stroke triage

Physicians may not be aware of such devices' intended use, with potential for misdiagnosis resulting in patient injury or death, the agency announced.