Fast Door-to-Needle Times for an MRI-Based Acute Stroke Protocol

Anthony S. Kim, MD, MAS reviewing Shah S et al. Neurology 2015 Jun 16.

A magnetic resonance imaging–based acute stroke protocol can consistently achieve DTN times of ≤60 minutes.

The initial acute stroke evaluation typically includes a noncontrast computed tomography (CT) to assess for intracerebral hemorrhage and early ischemic changes. Although magnetic resonance imaging (MRI) provides more information on the distribution and extent of acute ischemia, the concerns about the cost and complexity of the infrastructure required to provide immediate access to MRI and the potential for introducing treatment delays have limited the widespread adoption of acute MRI to screen patients for intravenous tissue plasminogen activator (IV tPA).

Now, researchers report the results of a quality improvement (QI) effort to reduce door-to-needle (DTN) times for two centers with existing MRI-based IV tPA protocols. A formal QI process identified distinct barriers to faster treatment at each center and some similar ones as well. Before, during, and after implementation of changes in 2013, most (135/157; 86%) IV tPA–treated patients continued to be screened with acute MRI. However, the median DTN time went from 93 minutes in the first half of 2012 to 55 minutes in the last half of 2013, and the percentage treated in ≤60 minutes increased from 13% to 62% over that same period. Thus, an MRI-based acute-stroke protocol achieved a performance benchmark that had been previously applied to predominantly CT-based centers nationwide.

Citation(s):

Shah S et al. Screening with MRI for accurate and rapid stroke treatment: SMART. Neurology 2015 Jun 16; 84:2438.