Endovascular treatment for acute ischaemic stroke with large vessel occlusion: the experience of a regional stroke service.

AIM: To report the experience of a regional stroke referral service with endovascular treatment for patients with acute ischaemic stroke (AIS) and large vessel occlusion. MATERIALS AND METHODS: A prospective review was undertaken of 93 consecutive cases receiving endovascular treatment for AIS over a 42-month period (January 2010 to June 2013). The National Institutes of Health Stroke Scale (NIHSS), location of large vessel occlusion, details of endovascular procedure, and degree of reperfusion achieved (Thrombolysis In Cerebral Infarction [TICI] score) were recorded. Mortality and functional outcome (modified Rankin Scale [mRS]) were measured at 90 days. RESULTS: The mean patient age was 62 years (range 26-87 years). The mean NIHSS at presentation was 16 (range 6-29). All patients had confirmed proximal large-artery occlusion on computed tomography (CT) angiography: 87 in the anterior circulation, six in the posterior circulation. Of the 93 patients treated, 64 (69%) received intravenous thrombolysis. Successful reperfusion (TICI grade 2a to 3) was achieved in 80 (86%) cases. There were 13 (14%) cases of failed vessel recanalisation (TICI grade 0). Good functional outcome (mRS ≤2) was achieved in 51 (55%) cases. The 90-day mortality was 20 (22%) cases. Fifty-seven (61%) cases were transferred from outside centres. There was no significant increase in morbidity or mortality for transferred patients. CONCLUSION: Successful endovascular recanalisation can result in good functional outcomes for patients with AIS and large vessel occlusion. Our interventional neuroradiology service provides endovascular treatment as part of a regional stroke service without increase in morbidity or mortality for patients transferred from outside institutions.

Survey of medical students and junior house doctors on the effects of medical radiation: is medical education deficient?

BACKGROUND: We investigated the knowledge of ionising radiation among medical students and junior doctors in Ireland and assessed whether this knowledge improved with clinical experience. METHODS: A total of 269 subjects completed a questionnaire on the fundamentals of diagnostic imaging and patient doses. RESULTS: Overall knowledge was poor, 99% of subjects underestimated the dose of radiation involved in a barium enema, plain film of abdomen, lumbar spine X-ray and a PET scan. Almost 90% underestimated the dose of a CT abdomen/pelvis. 42% of subjects knew that PET involved ionising radiation while 27% thought that MRI did. There was a significant improvement in understanding after transition to a clinical environment, however, no further development. 1% had attended formal radiation protection courses. CONCLUSION: The knowledge of basic radiological procedures and patient doses was extremely limited. Current undergraduate teaching needs to be expanded and continued post-qualification to improve core understanding and facilitate safe practice.