Objective: There are many combinations of studies for imaging the cervicocranial vasculature for diagnosis of ischemic stroke mechanism. We demonstrate a simple approach for using data from a stroke database to determine an optimal sequence of imaging studies on the basis of cost minimization and diagnostic yield. Methods: Our study uses patient data from the Hennepin County Medical Center stroke database, Minneapolis, Minn, to compare two vascular imaging protocols. In protocol 1, carotid ultrasound was the first vascular investigation for clinically determined anterior circulation strokes. Additional imaging with cervical and intracranial magnetic resonance angiography was obtained in nonanterior circulation cases and in cases when carotid ultrasound did not explain the mechanism for anterior circulation events. In protocol 2, cervical and intracranial magnetic resonance angiography was the first vascular investigation irrespective of the presumed topography of the stroke. Results: The mean cost per patient for imaging workup with protocol 1 was $702. With protocol 2, the cost was $679. Protocol 2 also provided clinically relevant information regarding tandem lesions and variations in intracranial collateral patterns that would have been missed by strictly following protocol 1. Conclusions: Our results indicate that, given our hospital costs and patient population, obtaining a cervical and intracranial magnetic resonance angiogram after acute ischemic stroke leads to a lower average cost per patient than obtaining a carotid ultrasound first on presumed anterior circulation events. This result depends on the relative costs of imaging studies and could be different among hospitals serving different patient populations.
|Original language||English (US)|
|Number of pages||5|
|Journal||Journal of Stroke and Cerebrovascular Diseases|
|State||Published - May 2004|
Bibliographical noteFunding Information:
Supported by a clinical research training fellowship from the American Academy of Neurology (Dr Lakshminarayan). The Hennepin County Medical Center Stroke database is maintained by grant MMRF 3434.
- Carotid ultrasound
- imaging protocol
- stroke database