TY  - BOOK
AU  - Hsia, Amie W
AU  - Kalaria, Chandni P
TI  - Routine use of FLAIR-negative MRI in the treatment of unknown onset stroke
SN  - 1052-3057
PY  - 2020///
KW  - *Fibrinolytic Agents/ad [Administration & Dosage]
KW  - *Magnetic Resonance Imaging
KW  - *Stroke/dg [Diagnostic Imaging]
KW  - *Stroke/dt [Drug Therapy]
KW  - *Thrombolytic Therapy
KW  - *Tissue Plasminogen Activator/ad [Administration & Dosage]
KW  - Aged
KW  - Aged, 80 and over
KW  - Clinical Decision-Making
KW  - Female
KW  - Fibrinolytic Agents/ae [Adverse Effects]
KW  - Humans
KW  - Male
KW  - Middle Aged
KW  - Patient Selection
KW  - Predictive Value of Tests
KW  - Registries
KW  - Retrospective Studies
KW  - Stroke/et [Etiology]
KW  - Thrombolytic Therapy/ae [Adverse Effects]
KW  - Time Factors
KW  - Time-to-Treatment
KW  - Tissue Plasminogen Activator/ae [Adverse Effects]
KW  - Treatment Outcome
KW  - MedStar Washington Hospital Center
KW  - Neurology
KW  - Journal Article
N2  - BACKGROUND: Treatment of FLAIR-negative stroke in patients presenting in an unknown time window has been shown to be safe and effective. However, implementation can be challenging due to the need for hyper-acute MRI screening. The purpose of this study was to review the routine application of this practice outside of a clinical trial; CONCLUSIONS: Screening stroke patients in an unknown time window with MRI is practical in a real-world setting and increases IV tPA utilization. Copyright Published by Elsevier Inc; METHODS: Patients presenting from 3/1/16 to 8/22/18 in a time window <4.5 h from symptom discovery but >4.5 h from last known normal were included if they had a hyper-acute MRI performed. Quantitative assessment based on the MR WITNESS trial and qualitative assessment based on the WAKE-UP trial were used to grade the FLAIR images. The MR WITNESS trial used a quantitative assessment of FLAIR change where the fractional increase in signal change had to be <1.15, whereas the WAKE-UP trial used a visual assessment requiring the absence of marked FLAIR signal changes; RESULTS: During the study period, 136 stroke patients presented and were imaged in the specified time window. Of these, 17 (12.5%) received IV tPA. Three patients had hemorrhage on 24-h MRI follow up; none had an increase in NIHSS >=4. Of the 119 patients who were screened but not treated, 18 (15%) were eligible based on FLAIR quantitative assessment and 55 (46%) were eligible based on qualitative assessment. In all cases where patients were not treated, there was an identifiable exclusion based on trial criteria. During the study period, IV tPA utilization was increased by 5.6% due to screening and treating patients with unknown onset stroke
UR  - https://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105093
UR  - https://dx.doi.org/10.1016/j.jstrokecerebrovasdis.2020.105093
ER  -