Evidence map›Paper›PMID 41084293›Full record

ArticleJournal of stroke2025

Moving From CT-First to MRI-First Paradigm in Acute Ischemic Stroke: Treatment Rates, Time Metrics, Safety, and Outcomes.

Costanza Maria Rapillo, Vincent Dunet, Alexander Salerno, Silvia Pistocchi, Vincent Darioli, Bruno Bartolini, Francesco Puccinelli, Steven David Hajdu, Guillaume Saliou, Patrik Michel and 1 more

Abstract read
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In one paragraph

Article in Journal of stroke, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

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.

2 · The registry

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.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed.

  1. Article
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

11 authors.

Costanza Maria RapilloStroke Center, Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
Vincent DunetNeuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Alexander SalernoStroke Center, Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
Silvia PistocchiNeuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Vincent DarioliEmergency Department, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Bruno BartoliniNeuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Francesco PuccinelliNeuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Steven David HajduNeuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Guillaume SaliouNeuroradiology Unit, Service of Diagnostic and Interventional Radiology, Department of Medical Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Patrik MichelStroke Center, Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.
Davide StramboStroke Center, Service of Neurology, Department of Clinical Neurosciences, University Hospital of Lausanne and University of Lausanne, Lausanne, Switzerland.

Funding

European Academy of Neurology
6 · The paper itself

Abstract

background and purposeNeuroimaging is essential before intravenous thrombolysis (IVT) and endovascular treatment (EVT) for acute ischemic stroke (AIS). In May 2018, our center transitioned from computed tomography (CT) to magnetic resonance imaging (MRI) as the first-line imaging for suspected AIS. We aimed to assess the consequences of an MRI-based paradigm on patients' selection, rates of acute treatment, time metrics, safety of both IVT and EVT, and clinical outcomes.

methodsUsing data from the Acute STroke Registry and Analysis of Lausanne (ASTRAL), we analyzed an equal number of patients from the CT-period (December 2012 to May 2018) and the subsequent MRI-period (May 2018 to August 2022). We performed univariable and multivariable analysis.

resultsWe included 2,972 consecutive AIS patients, 1,131 undergoing IVT and 662 EVT. Compared to the CT-period, the MRI-period showed similar rates of early and late IVT and EVT. The potentially missed-IVT opportunities decreased (3.1% vs. 0.8%; Padj<0.01). Median door-to-needle time was longer in the MRI-period (43 min vs. 31 min, β-coefficientadj=15, 95% confidence interval [CI]=11-27, Padj<0.01), while door-to-puncture time was unchanged (β-coefficientadj=9.95, 95% CI=-2.24-22.14, Padj=0.11). Rates of symptomatic intracranial hemorrhage (SICH) were similar after IVT (5.6% vs. 3.2%, Padj= 0.99) and EVT (±IVT) (6.5% vs. 4.2%, Padj=0.52). Disability at 3 months was unaffected for both IVT and EVT patients (Padj=0.36 and Padj=0.52 respectively).

conclusionThe transition from CT to MRI as the first-line imaging reduced the rates of potentially missed IVT opportunities. While door-to-needle time increased, door-to-puncture time remained stable. Safety as measured by SICH rates and 3-month disability were unaffected by the imaging paradigm shift.

Indexed as

Door-to-groinDoor-to-needleEndovascular treatmentIntravenous thrombolysisNeuroimagingStroke

Identifiers

PMID41084293
PMCPMC12527576

What OpenQuestion holds

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LicenceCC BY-NC
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Registered trials

None linked

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.