TY - JOUR
T1 - Association of Noncontrast Computed Tomography and Perfusion Modalities with Outcomes in Patients Undergoing Late-Window Stroke Thrombectomy
AU - Porto, Guilherme B.F.
AU - Chen, Ching Jen
AU - Al Kasab, Sami
AU - Essibayi, Muhammed Amir
AU - Almallouhi, Eyad
AU - Hubbard, Zachary
AU - Chalhoub, Reda
AU - Alawieh, Ali
AU - Maier, Ilko
AU - Psychogios, Marios Nikos
AU - Wolfe, Stacey Q.
AU - Jabbour, Pascal
AU - Rai, Ansaar
AU - Starke, Robert M.
AU - Shaban, Amir
AU - Arthur, Adam
AU - Kim, Joon Tae
AU - Yoshimura, Shinichi
AU - Grossberg, Jonathan
AU - Kan, Peter
AU - Fragata, Isabel
AU - Polifka, Adam
AU - Osbun, Joshua
AU - Mascitelli, Justin
AU - Levitt, Michael R.
AU - Williamson, Richard
AU - Romano, Daniele G.
AU - Crosa, Roberto
AU - Gory, Benjamin
AU - Mokin, Maxim
AU - Limaye, Kaustubh S.
AU - Casagrande, Walter
AU - Moss, Mark
AU - Grandhi, Ramesh
AU - Yoo, Albert
AU - Spiotta, Alejandro M.
AU - Park, Min S.
N1 - Publisher Copyright:
© 2022 American Medical Association. All rights reserved.
PY - 2022/11/11
Y1 - 2022/11/11
N2 - Importance: There is substantial controversy with regards to the adequacy and use of noncontrast head computed tomography (NCCT) for late-window acute ischemic stroke in selecting candidates for mechanical thrombectomy. Objective: To assess clinical outcomes of patients with acute ischemic stroke presenting in the late window who underwent mechanical thrombectomy stratified by NCCT admission in comparison with selection by CT perfusion (CTP) and diffusion-weighted imaging (DWI). Design, Setting, and Participants: In this multicenter retrospective cohort study, prospectively maintained Stroke Thrombectomy and Aneurysm (STAR) database was used by selecting patients within the late window of acute ischemic stroke and emergent large vessel occlusion from 2013 to 2021. Patients were selected by NCCT, CTP, and DWI. Admission Alberta Stroke Program Early CT Score (ASPECTS) as well as confounding variables were adjusted. Follow-up duration was 90 days. Data were analyzed from November 2021 to March 2022. Exposures: Selection by NCCT, CTP, or DWI. Main Outcomes and Measures: Primary outcome was functional independence (modified Rankin scale 0-2) at 90 days. Results: Among 3356 patients, 733 underwent late-window mechanical thrombectomy. The median (IQR) age was 69 (58-80) years, 392 (53.5%) were female, and 449 (65.1%) were White. A total of 419 were selected with NCCT, 280 with CTP, and 34 with DWI. Mean (IQR) admission ASPECTS were comparable among groups (NCCT, 8 [7-9]; CTP, 8 [7-9]; DWI 8, [7-9]; P =.37). There was no difference in the 90-day rate of functional independence (aOR, 1.00; 95% CI, 0.59-1.71; P =.99) after adjusting for confounders. Symptomatic intracerebral hemorrhage (NCCT, 34 [8.6%]; CTP, 37 [13.5%]; DWI, 3 [9.1%]; P =.12) and mortality (NCCT, 78 [27.4%]; CTP, 38 [21.1%]; DWI, 7 [29.2%]; P =.29) were similar among groups. Conclusions and Relevance: In this cohort study, comparable outcomes were observed in patients in the late window irrespective of neuroimaging selection criteria. Admission NCCT scan may triage emergent large vessel occlusion in the late window.
AB - Importance: There is substantial controversy with regards to the adequacy and use of noncontrast head computed tomography (NCCT) for late-window acute ischemic stroke in selecting candidates for mechanical thrombectomy. Objective: To assess clinical outcomes of patients with acute ischemic stroke presenting in the late window who underwent mechanical thrombectomy stratified by NCCT admission in comparison with selection by CT perfusion (CTP) and diffusion-weighted imaging (DWI). Design, Setting, and Participants: In this multicenter retrospective cohort study, prospectively maintained Stroke Thrombectomy and Aneurysm (STAR) database was used by selecting patients within the late window of acute ischemic stroke and emergent large vessel occlusion from 2013 to 2021. Patients were selected by NCCT, CTP, and DWI. Admission Alberta Stroke Program Early CT Score (ASPECTS) as well as confounding variables were adjusted. Follow-up duration was 90 days. Data were analyzed from November 2021 to March 2022. Exposures: Selection by NCCT, CTP, or DWI. Main Outcomes and Measures: Primary outcome was functional independence (modified Rankin scale 0-2) at 90 days. Results: Among 3356 patients, 733 underwent late-window mechanical thrombectomy. The median (IQR) age was 69 (58-80) years, 392 (53.5%) were female, and 449 (65.1%) were White. A total of 419 were selected with NCCT, 280 with CTP, and 34 with DWI. Mean (IQR) admission ASPECTS were comparable among groups (NCCT, 8 [7-9]; CTP, 8 [7-9]; DWI 8, [7-9]; P =.37). There was no difference in the 90-day rate of functional independence (aOR, 1.00; 95% CI, 0.59-1.71; P =.99) after adjusting for confounders. Symptomatic intracerebral hemorrhage (NCCT, 34 [8.6%]; CTP, 37 [13.5%]; DWI, 3 [9.1%]; P =.12) and mortality (NCCT, 78 [27.4%]; CTP, 38 [21.1%]; DWI, 7 [29.2%]; P =.29) were similar among groups. Conclusions and Relevance: In this cohort study, comparable outcomes were observed in patients in the late window irrespective of neuroimaging selection criteria. Admission NCCT scan may triage emergent large vessel occlusion in the late window.
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U2 - 10.1001/jamanetworkopen.2022.41291
DO - 10.1001/jamanetworkopen.2022.41291
M3 - Article
C2 - 36367728
AN - SCOPUS:85141893575
SN - 2574-3805
VL - 5
SP - E2241291
JO - JAMA network open
JF - JAMA network open
IS - 11
ER -