Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows.

Details

Serval ID
serval:BIB_61D6B5F6A33C
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows.
Journal
Stroke
Author(s)
Nogueira R.G., Haussen D.C., Liebeskind D., Jovin T.G., Gupta R., Jadhav A., Budzik R.F., Baxter B., Krajina A., Bonafe A., Malek A., Narata A.P., Shields R., Zhang Y., Morgan P., Bartolini B., English J., Frankel M.R., Veznedaroglu E.
Working group(s)
Trevo Registry and DAWN Trial Investigators
ISSN
1524-4628 (Electronic)
ISSN-L
0039-2499
Publication state
Published
Issued date
12/01/2021
Peer-reviewed
Oui
Pages
STROKEAHA120031685
Language
english
Notes
Publication types: Journal Article
Publication Status: aheadofprint
Abstract
Advanced imaging has been increasingly used for patient selection in endovascular stroke therapy. The impact of imaging selection modality on endovascular stroke therapy clinical outcomes in extended time window remains to be defined. We aimed to study this relationship and compare it to that noted in early-treated patients.
Patients from a prospective multicentric registry (n=2008) with occlusions involving the intracranial internal carotid or the M1- or M2-segments of the middle cerebral arteries, premorbid modified Rankin Scale score 0 to 2 and time to treatment 0 to 24 hours were categorized according to treatment times within the early (0-6 hour) or extended (6-24 hour) window as well as imaging modality with noncontrast computed tomography (NCCT)±CT angiography (CTA) or NCCT±CTA and CT perfusion (CTP). The association between imaging modality and 90-day modified Rankin Scale, analyzed in ordinal (modified Rankin Scale shift) and dichotomized (functional independence, modified Rankin Scale score 0-2) manner, was evaluated and compared within and across the extended and early windows.
In the early window, 332 patients were selected with NCCT±CTA alone while 373 also underwent CTP. After adjusting for identifiable confounders, there were no significant differences in terms of 90-day functional disability (ordinal shift: adjusted odd ratio [aOR], 0.936 [95% CI, 0.709-1.238], P=0.644) or independence (aOR, 1.178 [95% CI, 0.833-1.666], P=0.355) across the CTP and NCCT±CTA groups. In the extended window, 67 patients were selected with NCCT±CTA alone while 180 also underwent CTP. No significant differences in 90-day functional disability (aOR, 0.983 [95% CI, 0.81-1.662], P=0.949) or independence (aOR, 0.640 [95% CI, 0.318-1.289], P=0.212) were seen across the CTP and NCCT±CTA groups. There was no interaction between the treatment time window (0-6 versus 6-24 hours) and CT selection modality (CTP versus NCCT±CTA) in terms of functional disability at 90 days (P=0.45).
CTP acquisition was not associated with better outcomes in patients treated in the early or extended time windows. While confirmatory data is needed, our data suggests that extended window endovascular stroke therapy may remain beneficial even in the absence of advanced imaging.
Keywords
angiography, internal carotid artery, magnetic resonance imaging, middle cerebral artery, patient selection
Pubmed
Create date
13/01/2021 11:14
Last modification date
14/01/2021 6:26
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