Acute stroke imaging protocols and decision-making criteria for endovascular thrombectomy in acute ischemic stroke: a nationwide survey of thrombectomy-capable centers in Korea

Abstract

Background and purpose Standardized imaging protocols and eligibility criteria are essential for optimizing endovascular thrombectomy (EVT) in acute ischemic stroke. This study investigated current imaging protocols and EVT eligibility criteria across different time windows in Korea. Methods This nationwide cross-sectional survey used a comprehensive 58-item electronic questionnaire was distributed to stroke neurologists, vascular neurosurgeons, and interventional neuroradiologists at 77 thrombectomycapable stroke centers (TSCs) certified by the Korean Stroke Society. The survey assessed acute imaging protocols and EVT eligibility criteria across time windows: early (< 6 h), late (6-16 h and 16-24 h), and extended (24-48 h) from symptom onset. Responses were collected from July-December 2024. Results Forty-nine physicians from 45 (58.4%) centers responded. Computed tomography (CT)-based imaging was the predominant modality across all time windows (< 6 h: 71.1%; 6-16 h: 51.2%; 16-24 h: 52.4%; 24-48 h: 40%). The proportion of TSCs implementing perfusion imaging increased with longer time windows (< 6 h: 73.3%; 6-16 h: 86.0%; 16-24 h: 88.1%; 24-48 h: 100%; p for trend < 0.01). Vendor-provided automated software was most commonly used for detecting perfusion abnormalities, while among centers employing advanced automated post-processing software, Rapid Processing of Perfusion and Diffusion software was the predominant program. Physicians used perfusion-based criteria commonly in late time windows: 32 (68.1%) at 6-16 h, 31 (67.4%) at 16-24 h. Conclusions This nationwide multicenter survey revealed substantial heterogeneity in imaging protocols and EVT eligibility criteria among Korean TSCs, underscoring the need for standardized imaging protocols and eligibility criteria for EVT.