RT Journal Article
A1 Nguyen, Thanh N.
A1 Abdalkader, Mohamad
A1 Nagel, Simon
A1 Qureshi, Muhammad M.
A1 Ribo, Marc
A1 Caparros, Francois
A1 Haussen, Diogo C.
A1 Mohammaden, Mahmoud H.
A1 Sheth, Sunil A.
A1 Ortega-Gutierrez, Santiago
A1 Siegler, James E.
A1 Zaidi, Syed
A1 Olive-Gadea, Marta
A1 Henon, Hilde
A1 Möhlenbruch, Markus A.
A1 Castonguay, Alicia C.
A1 Nannoni, Stefania
A1 Kaesmacher, Johannes
A1 Puri, Ajit S.
A1 Seker, Fatih
A1 Farooqui, Mudassir
A1 Salazar-Marioni, Sergio
A1 Kuhn, Anna L.
A1 Kaliaev, Artem
A1 Farzin, Behzad
A1 Boisseau, William
A1 Masoud, Hesham E.
A1 Lopez, Carlos Ynigo
A1 Rana, Ameena
A1 Kareem, Samer Abdul
A1 Sathya, Anvitha
A1 Klein, Piers
A1 Kassem, Mohammad W.
A1 Ringleb, Peter A.
A1 Cordonnier, Charlotte
A1 Gralla, Jan
A1 Fischer, Urs
A1 Michel, Patrik
A1 Jovin, Tudor G.
A1 Raymond, Jean
A1 Zaidat, Osama O.
A1 Nogueira, Raul G.
T1 Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion
JF ÁñÁ«ÊÓƵ Neurology
JO ÁñÁ«ÊÓƵ Neurol
YR 2022
DO 10.1001/jamaneurol.2021.4082
VO 79
IS 1
SP 22
OP 31
SN 2168-6149
AB 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.
RD 5/20/2024
UL https://doi.org/10.1001/jamaneurol.2021.4082