Journal article
Association of Noncontrast Computed Tomography and Perfusion Modalities With Outcomes in Patients Undergoing Late-Window Stroke Thrombectomy
JAMA network open, Vol.5(11), pp.e2241291-e2241291
01/01/2022
DOI: 10.1001/jamanetworkopen.2022.41291
PMCID: PMC9652750
PMID: 36367728
Abstract
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.
Details
- Title: Subtitle
- Association of Noncontrast Computed Tomography and Perfusion Modalities With Outcomes in Patients Undergoing Late-Window Stroke Thrombectomy
- Creators
- Guilherme PortoChing-Jen ChenSami Al Kasab - Medical University of South CarolinaMuhammed Amir Essibayi - Medical University of South CarolinaEyad Almallouhi - Medical University of South CarolinaZachary Hubbard - Medical University of South CarolinaReda Chalhoub - Medical University of South CarolinaAli Alawieh - Emory UniversityIlko Maier - University of GöttingenMarios-Nikos Psychogios - University of BaselStacey Wolfe - Wake Forest UniversityPascal Jabbour - Thomas Jefferson UniversityAnsaar Rai - West Virginia UniversityRobert Starke - University of Miami Health SystemAmir Shaban - University of IowaAdam ArthurJoon-Tae KimShinichi Yoshimura - Hyogo Medical UniversityJonathan Grossberg - Emory UniversityPeter Kan - The University of Texas Medical Branch at GalvestonIsabel Fragata - Hospital de São JoséAdam Polifka - University of FloridaJoshua Osbun - Washington University in St. LouisJustin Mascitelli - The University of Texas Health Science Center at San AntonioMichael Levitt - University of WashingtonRichard Williamson - Allegheny Health NetworkDaniele Romano - Ospedali Riuniti San Giovanni di Dio e Ruggi d'AragonaRoberto Crosa - Neurological SurgeryBenjamin Gory - Centre Hospitalier Universitaire de NancyMaxim Mokin - University of South FloridaKaustubh Limaye - Indiana University – Purdue University IndianapolisWalter Casagrande - Hospital FernándezMark Moss - Washington Regional Medical CenterRamesh Grandhi - University of UtahAlbert Yoo - The Texas Heart InstituteAlejandro Spiotta - Medical University of South CarolinaMin Park - University of Virginia Health SystemStroke Thrombectomy and Aneurysm Registry (STAR) Collaborators
- Resource Type
- Journal article
- Publication Details
- JAMA network open, Vol.5(11), pp.e2241291-e2241291
- DOI
- 10.1001/jamanetworkopen.2022.41291
- PMID
- 36367728
- PMCID
- PMC9652750
- NLM abbreviation
- JAMA Netw Open
- eISSN
- 2574-3805
- Publisher
- American Medical Association
- Language
- English
- Date published
- 01/01/2022
- Academic Unit
- Neurology
- Record Identifier
- 9984317369102771
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