Table 1.

The effect of imaging modality on treatment decision-making.

Study citation	n	Imaging	Design	Results
Lima et al., 2014103	126	CTA	P	In adult patients with CTA demonstrating anterior circulation ischemic stroke with symptoms within 24 hours of onset, these treatment modalities were chosen: --IV-tPA: 51 (23.7%) --IA-tPA: 10 (4.6%) --IV and IA-tPA: 16 (7.4%) --No treatment: 138 (64.2%)
Chung et al., 2013104	57	FLAIR	P	In adult patients with acute ischemic stroke who present with 2.5 hours of onset of symptoms, have MRI/MRA-confirmed persistence of occlusion after IV-tPA, and were afterward treated with an IA form of thrombolysis, these treatment modalities were chosen based on the presence of FLAIR-hyperintense lesions: --“Chemical thrombolysis”: 29 (90.6%) --Mechanical thrombolysis: 28 (87.5%) --Balloon angioplasty: 12 (37.5%) --PENUMBRAa: 4 (12.5%) --Stenting: 5 (15.6%)
Kidwell et al., 2013105	66	Multimodal MRI, NCCT	P	In adult patients with acute ischemic stroke demonstrated by multimodal MRI or CT demonstrated in anterior large-vessel circulation with therapy initiated within eight hours of symptoms, recanalization TIMI of 2–3, and follow-up imaging within seven days, these treatment modalities were chosen: Multimodal MRI (34 patients): --IA-tPA: 12 (35.3%) --Bridging IV-tPA to IA-tPA: 11 (32.4%) --Mechanical thrombectomy: 11 (32.4%) CT (32 patients) --IV-tPA: 3 (9.4%) --Mechanical thrombectomy: 1 (3.1%) --Bridging IV-tPA to endovascular: 12 (37.5%) --Combined mechanical thrombectomy and IA-tPA: 16 (50%)
Kang et al., 2012106	430	MRI	P	In adult patients with unclear-onset stroke with PWI/DWI mismatch >20%, negative or subtle FLAIR changes, these treatment modalities were chosen: --Reperfusion therapy given: 83 (19.3%) • IA-tPA: 57 (68.7%) • IV-tPA + IA-tPA: 17 (20.5%) • IV-tPA: 9 (10.8%) --No reperfusion therapy: 347 (80.7%)
Salottolo et al., 2011107	108	Multimodal CT (CTA, PCT, NCCT)	R	In adult patients with acute ischemic stroke with symptom onset to hospital arrival <2.5 hours, when multimodal CT is added to the diagnostic workup, the following effects on tPA administration were noted: --Median time from arrival to tPA was shorter with multimodal CT than for those evaluated with only NCCT (55 vs. 78 minutes, p = 0.02) --No significant difference in odds ratio of receiving timely tPA (<60 minutes) for those evaluated with multimodal CT in addition to NCCT
Thomas et al., 2011108	207	CTA	R	In adult patients with acute ischemic stroke presenting within 24 hours of symptom onset who underwent emergent CTA, these treatment modalities were chosen: --IV-tPA: 25% --IA-tPA: 2.4% --Mechanical thrombectomy: 6.8% --Surgery: 3.3% --Admitted to neuroscience ICU: 52%
Hassan et al., 2010109	164	CTP	R	In adult patients with acute ischemic stroke treated with endovascular approaches based on either CTP or time interval between symptom onset and presentation, these treatment modalities were chosen: Time-Guided treatment (103 patients): --IV-tPA: 47 (37%) --IA-tPA: 84 (66%) --Mechanical thrombectomy: 41 (32%) --Angioplasty: 37 (29%) CTP-Guided treatment (61 patients): --IV-tPA: 32 (46%) --IA-tPA: 50 (72%) --Mechanical thrombectomy: 27 (39%) --Angioplasty: 26 (38%)

^aPENUMBRA: Food and Drug Administration (FDA)-approved device for clot aspiration, debulking, and retrieval. CTA: computed tomography angiography; NCCT: non-contrast computed tomography; DWI: diffusion-weighted imaging; PWI: perfusion-weighted imaging; TCD: transcranial Doppler ultrasonography; IV-tPA: intravenous tissue plasminogen activator; IA-tPA: intra-arterial tissue plasminogen activator; MRI: magnetic resonance imaging; MRA: magnetic resonance angiography; FLAIR: fluid-attenuated inversion recovery; TIMI: Thrombolysis in Myocardial Infarction score.