ArticleNeurology2015
Screening with MRI for Accurate and Rapid Stroke Treatment: SMART.
Article in Neurology, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 37 papers, 3 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
37 citing papers in PubMed, 3 syntheses or guidelines pooled it, 73 citations in OpenAlex.
- Exploring the potential of machine learning and magnetic resonance imaging in early stroke diagnosis: a bibliometric analysis (2004-2023).Frontiers in neurology · 2025Pooled it
- Neuroimaging in Randomized, Multi-Center Clinical Trials of Endovascular Treatment for Acute Ischemic Stroke: A Systematic Review.Korean journal of radiology · 2020Pooled it
- Pooled it
- MRI vs CT for Baseline Imaging Evaluation in Acute Large Artery Ischemic Stroke: A Subanalysis of the SWIFT-DIRECT TrialNeurology · 2024Trial
- Moving From CT-First to MRI-First Paradigm in Acute Ischemic Stroke: Treatment Rates, Time Metrics, Safety, and Outcomes.Journal of stroke · 2025Article
- Decomposing door-to-needle time: insights into workflow delays and quality improvement in acute stroke care.Frontiers in neurology · 2025Article
- Blood-brain barrier disruption mediates the association between cerebral small vessel disease and clinical outcome after stroke: a secondary analysis of the Lesion Evolution in Stroke and Ischemia on Neuroimaging study.Frontiers in stroke · 2024Article
- Brain imaging with portable low-field MRI.Nature reviews bioengineering · 2023Article
- 3D magnetic resonance fingerprinting on a low-field 50 mT point-of-care system prototype: evaluation of muscle and lipid relaxation time mapping and comparison with standard techniques.Magma (New York, N.Y.) · 2023Article
- Association of Long Non-Coding RNA Malat1 with Serum Levels of Interleukin-1 Beta and Vitamin D in Patients with Ischemic Stroke.Galen medical journal · 2023Article
- Retinal and optic nerve magnetic resonance diffusion-weighted imaging in acute non-arteritic central retinal artery occlusion.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2022Article
- Magnetic Resonance Imaging or Computed Tomography for Suspected Acute Stroke: Association of Admission Image Modality with Acute Recanalization Therapies, Workflow Metrics, and Outcomes.Annals of neurology · 2022Observational
- Current approaches and advances in the imaging of stroke.Disease models & mechanisms · 2021Review
- Portable, bedside, low-field magnetic resonance imaging for evaluation of intracerebral hemorrhage.Nature communications · 2021Observational
- Cost-Effectiveness of Advanced Neuroimaging for Transient and Minor Neurological Events in the Emergency Department.Journal of the American Heart Association · 2021Article
- Article
- Methodology for Low-Field, Portable Magnetic Resonance Neuroimaging at the Bedside.Frontiers in neurology · 2021Article
- Routine use of FLAIR-negative MRI in the treatment of unknown onset stroke.Journal of stroke and cerebrovascular diseases : the official journal of National Stroke Association · 2020Article
- Biomarker Application for Precision Medicine in Stroke.Translational stroke research · 2020Review
- Accuracy of MRI T2*-weighted sequences (GRE-EPI) compared to CTA for detection of anterior circulation large vessel thrombus.Emergency radiology · 2020Article
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Authors and funding
9 authors at 1 institution in 1 country.
Funding
Abstract
objectiveThe objective of this study was to demonstrate the feasibility of timely multimodal MRI screening before thrombolysis in acute stroke patients.
methodsQuality improvement processes were initiated in 2013 to reduce door-to-needle (DTN) time at the 2 hospitals where the NIH stroke team provides clinical care. Acute ischemic stroke (AIS) patients who received IV tissue plasminogen activator (tPA) ≤4.5 hours from last known normal were identified. Demographic and clinical characteristics and timing metrics were analyzed comparing the time periods before, during, and after the quality improvement processes.
resultsThere were 157 patients treated with IV tPA for AIS during 2012-2013, of whom 135 (86%) were screened with MRI. DTN time was significantly reduced by 40% during this period from a median of 93 minutes in the first half of 2012 to 55 minutes in the last half of 2013 (p < 0.0001) with a significant 4-fold increase in the proportion of treated patients with DTN time ≤60 minutes from 13.0% to 61.5%, respectively (p < 0.00001). Improvement in DTN time was associated with reduced door-to-MRI time, and there were no differences in demographic or clinical characteristics (p = 0.21-0.76).
conclusionsIt is feasible and practical to consistently and rapidly deliver IV tPA to AIS patients within national benchmark times using MRI as the routine screening modality. The processes used in the SMART (Screening with MRI for Accurate and Rapid Stroke Treatment) Study to reduce DTN time have the potential to be widely applicable to other hospitals.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.