Neuroradiologists and stroke
============================

* Gordon J. Gubitz
* Stephen J. Phillips

We regret that some radiologists may feel slighted because their specialty was not explicitly listed among the members of our acute stroke team.1 We agree that radiologists, and neuroradiologists in particular, play an important and expanding role in the diagnosis and treatment of stroke.

We are pleased to have a close working relationship with the radiologists in our department of diagnostic imaging. Radiologists have been helpful in improving our ability to deliver care in a timely manner. Although waiting for a scan may be a rate-limiting step in the administration of tissue plasminogen activator, our protocol specifies that any candidate for such treatment is next in line for CT. We also have a rapid carotid Doppler ultrasonography service, so patients can be scanned immediately if they present to the emergency department during the day (the next day, including weekends, if they present after hours).

Our interventional neuroradiologists, in collaboration with neurosurgery and neurology specialists, treat aneurysms and arteriovenous malformations. We seldom use intra-arterial thrombolysis for acute ischemic stroke and do not perform angioplasty and stenting for carotid or vertebrobasilar occlusive disease, because of persisting uncertainty about the efficacy of these interventions. 

We hope that this letter helps to clarify the role that our radiologists play in the management of stroke patients.

**Gordon J. Gubitz** **Stephen J. Phillips** Division of Neurology Department of Medicine Dalhousie University and Queen Elizabeth II Health Sciences Centre Halifax, NS

## Reference

1.  1. Phillips SJ, Eskes GA, Gubitz GJ, on behalf of the Queen Elizabeth II Health Sciences Centre Acute Stroke Team. Description and evaluation of an acute stroke unit. CMAJ 2002;167(6):655-60.
    
    [Abstract/FREE Full Text](http://www.cmaj.ca/lookup/ijlink/YTozOntzOjQ6InBhdGgiO3M6MTQ6Ii9sb29rdXAvaWpsaW5rIjtzOjU6InF1ZXJ5IjthOjQ6e3M6ODoibGlua1R5cGUiO3M6NDoiQUJTVCI7czoxMToiam91cm5hbENvZGUiO3M6NDoiY21haiI7czo1OiJyZXNpZCI7czo5OiIxNjcvNi82NTUiO3M6NDoiYXRvbSI7czoyMjoiL2NtYWovMTY4LzIvMTUwLjMuYXRvbSI7fXM6ODoiZnJhZ21lbnQiO3M6MDoiIjt9)