Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion.

Details

Serval ID
serval:BIB_4F2897AF6E8A
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion.
Journal
JAMA neurology
Author(s)
Nguyen T.N., Abdalkader M., Nagel S., Qureshi M.M., Ribo M., Caparros F., Haussen D.C., Mohammaden M.H., Sheth S.A., Ortega-Gutierrez S., Siegler J.E., Zaidi S., Olive-Gadea M., Henon H., Möhlenbruch M.A., Castonguay A.C., Nannoni S., Kaesmacher J., Puri A.S., Seker F., Farooqui M., Salazar-Marioni S., Kuhn A.L., Kaliaev A., Farzin B., Boisseau W., Masoud H.E., Lopez C.Y., Rana A., Kareem S.A., Sathya A., Klein P., Kassem M.W., Ringleb P.A., Cordonnier C., Gralla J., Fischer U., Michel P., Jovin T.G., Raymond J., Zaidat O.O., Nogueira R.G.
ISSN
2168-6157 (Electronic)
ISSN-L
2168-6149
Publication state
Published
Issued date
01/01/2022
Peer-reviewed
Oui
Volume
79
Number
1
Pages
22-31
Language
english
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Abstract
Advanced imaging for patient selection in mechanical thrombectomy is not widely available.
To compare the clinical outcomes of patients selected for mechanical thrombectomy by noncontrast computed tomography (CT) vs those selected by computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) in the extended time window.
This multinational cohort study included consecutive patients with proximal anterior circulation occlusion stroke presenting within 6 to 24 hours of time last seen well from January 2014 to December 2020. This study was conducted at 15 sites across 5 countries in Europe and North America. The duration of follow-up was 90 days from stroke onset.
Computed tomography with Alberta Stroke Program Early CT Score, CTP, or MRI.
The primary end point was the distribution of modified Rankin Scale (mRS) scores at 90 days (ordinal shift). Secondary outcomes included the rates of 90-day functional independence (mRS scores of 0-2), symptomatic intracranial hemorrhage, and 90-day mortality.
Of 2304 patients screened for eligibility, 1604 patients were included, with a median (IQR) age of 70 (59-80) years; 848 (52.9%) were women. A total of 534 patients were selected to undergo mechanical thrombectomy by CT, 752 by CTP, and 318 by MRI. After adjustment of confounders, there was no difference in 90-day ordinal mRS shift between patients selected by CT vs CTP (adjusted odds ratio [aOR], 0.95 [95% CI, 0.77-1.17]; P = .64) or CT vs MRI (aOR, 0.95 [95% CI, 0.8-1.13]; P = .55). The rates of 90-day functional independence (mRS scores 0-2 vs 3-6) were similar between patients selected by CT vs CTP (aOR, 0.90 [95% CI, 0.7-1.16]; P = .42) but lower in patients selected by MRI than CT (aOR, 0.79 [95% CI, 0.64-0.98]; P = .03). Successful reperfusion was more common in the CT and CTP groups compared with the MRI group (474 [88.9%] and 670 [89.5%] vs 250 [78.9%]; P < .001). No significant differences in symptomatic intracranial hemorrhage (CT, 42 [8.1%]; CTP, 43 [5.8%]; MRI, 15 [4.7%]; P = .11) or 90-day mortality (CT, 125 [23.4%]; CTP, 159 [21.1%]; MRI, 62 [19.5%]; P = .38) were observed.
In patients undergoing proximal anterior circulation mechanical thrombectomy in the extended time window, there were no significant differences in the clinical outcomes of patients selected with noncontrast CT compared with those selected with CTP or MRI. These findings have the potential to widen the indication for treating patients in the extended window using a simpler and more widespread noncontrast CT-only paradigm.
Keywords
Arterial Occlusive Diseases/complications, Cohort Studies, Humans, Magnetic Resonance Imaging, Mechanical Thrombolysis, Perfusion Imaging, Stroke/complications, Stroke/diagnostic imaging, Stroke/pathology, Stroke/therapy, Tomography, X-Ray Computed, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
15/11/2021 16:33
Last modification date
12/03/2022 7:29
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