• Kunakorn Atchaneeyasakul, David S Liebeskind, Reza Jahan, Sidney Starkman, Latisha Sharma, Bryan Yoo, Johanna Avelar, Neal Rao, Jason Hinman, Gary Duckwiler, May Nour, Viktor Szeder, Satoshi Tateshima, Geoffrey Colby, Hosseini Mersedeh Bahr MB RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States., Radoslav Raychev, Doojin Kim, Jeffrey L Saver, and UCLA Reperfusion Therapy Investigators.
• RRMC-UCLA Comprehensive Stroke Center, 710 Westwood Plaza, Los Angeles 90095, CA ,United States. Electronic address: k.atchanee@gmail.com.
• J Stroke Cerebrovasc Dis. 2020 Dec 1; 29 (12): 105271.

BackgroundMRI and CT modalities are both current standard-of-care options for initial imaging in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). MR provides greater lesion conspicuity and spatial resolution, but few series have demonstrated multimodal MR may be performed efficiently.MethodsIn a prospective comprehensive stroke center registry, we analyzed all anterior circulation LVO thrombectomy patients between 2012-2017 who: (1) arrived directly by EMS from the field, and (2) had initial NIHSS ≥6. Center imaging policy was multimodal MRI (including DWI/GRE/MRA w/wo PWI) as the initial evaluation in all patients without contraindications, and multimodal CT (including CT with CTA, w/wo CTP) in the remainder.ResultsAmong 106 EMS-arriving endovascular thrombectomy patients, initial imaging was MRI 62.3%, CT in 37.7%. MRI and CT patients were similar in age (72.5 vs 71.3), severity (NIHSS 16.4 v 18.2), and medical history, though MRI patients had longer onset-to-door times. Overall, door-to-needle (DTN) and door-to-puncture (DTP) times did not differ among MR and CT patients, and were faster for both modalities in 2015-2017 versus 2012-2014. In the 2015-2017 period, for MR-imaged patients, the median DTN 42m (IQR 34-55) surpassed standard (60m) and advanced (45m) national targets and the median DTP 86m (IQR 71-106) surpassed the standard national target (90m).ConclusionsAIS-LVO patients can be evaluated by multimodal MR imaging with care speeds faster than national recommendations for door-to-needle and door-to-puncture times. With its more sensitive lesion identification and spatial resolution, MRI remains a highly viable primary imaging strategy in acute ischemic stroke patients, though further workflow efficiency improvements are desirable.Published by Elsevier Inc.

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