What Stroke Image Do We Want? European Clinician Survey On Acute Stroke Imaging And Revascularisation Treatment

OBJECTIVES: The cost-effectiveness of clinical interventions is often assessed using current care as a comparator. However, various imaging and treatment options are available in current stroke care and evidence suggests clinical practice variation in acute stroke imaging across European countries. This research aims to describe the patterns of stroke imaging and acute revascularisation therapy, examine variations across countries and obtain results reflecting current care that will be used in future cost-effectiveness analyses. METHODS: A web-based clinician survey was circulated through email distribution lists and websites of European professional societies. The survey focused on stroke imaging and revascularisation treatments. Statistical comparisons were performed in Excel and SPSS, and confidence intervals were estimated using bootstrapping. RESULTS: We received responses from Sweden (21), the UK (16), Hungary (15), Germany (12) and elsewhere in Europe (47). Large variations are observed in revascularisation treatment: German respondents report that 81% of their ischaemic stroke patients diagnosed with a large vessel occlusion within 4.5 hours receive intravenous thrombolysis and thrombectomy, while UK respondents report a very low percentage (12%). For patients diagnosed with an extensive ischaemic stroke within 2 hours from onset, 75% of UK-respondents state thrombectomy as their preferred revascularisation treatment, but only 13% report using it. Computed Tomography (CT) is indicated as the most widely used first imaging test (81-93% of patients across geographic areas), while Magnetic Resonance Imaging (MRI) is a distant second (6-26%). Wide variations in terms of proportion of patients and modality used are observed during the second-line imaging test. CONCLUSIONS: Revascularisation treatments given to stroke patients vary considerably across Europe, mainly because of barriers to thrombectomy. This study reinforces the need to compare the quality of stroke care in terms of process and outcomes between countries and to improve it. Research is also needed to investigate the cost-effectiveness of second-line imaging strategies.