Association of Noncontrast Computed Tomography and Perfusion Modalities With Outcomes in Patients Undergoing Late-Window Stroke Thrombectomy-Reference-Cited by-同舟云学术

Association of Noncontrast Computed Tomography and Perfusion Modalities With Outcomes in Patients Undergoing Late-Window Stroke Thrombectomy

Published:2022-11-11 Issue:11 Volume:5 Page:e2241291
ISSN:2574-3805
Container-title:JAMA Network Open
language:en
Short-container-title:JAMA Netw Open

Author:

Porto Guilherme B. F.¹,Chen Ching-Jen²,Al Kasab Sami¹,Essibayi Muhammed Amir¹,Almallouhi Eyad¹,Hubbard Zachary¹,Chalhoub Reda¹,Alawieh Ali³,Maier Ilko⁴,Psychogios Marios-Nikos⁵,Wolfe Stacey Q.⁶,Jabbour Pascal²,Rai Ansaar⁷,Starke Robert M.⁸,Shaban Amir⁹,Arthur Adam¹⁰,Kim Joon-Tae¹¹,Yoshimura Shinichi¹²,Grossberg Jonathan³,Kan Peter¹³,Fragata Isabel¹⁴,Polifka Adam¹⁵,Osbun Joshua¹⁶,Mascitelli Justin¹⁷,Levitt Michael R.¹⁸,Williamson Richard¹⁹,Romano Daniele G.²⁰,Crosa Roberto²¹,Gory Benjamin²²,Mokin Maxim²³,Limaye Kaustubh S.²⁴,Casagrande Walter²⁵,Moss Mark²⁶,Grandhi Ramesh²⁷,Yoo Albert²⁸,Spiotta Alejandro M.¹,Park Min S.²⁹,

Affiliation:

1. Department of Neurosurgery, Medical University of South Carolina, Charleston

2. Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania

3. Department of Neurosurgery, Emory University, Atlanta, Georgia

4. Department of Neurology, University Medical Center Göttingen, Göttingen, Germany

5. Department of Radiology, University of Basel, Basel, Switzerland

6. Department of Neurosurgery, Wake Forest University, Winston-Salem, North Carolina

7. Department of Radiology, West Virginia University, Morgantown

8. Department of Neurosurgery, University of Miami Health System, Miami, Florida

9. Department of Neurology, University of Iowa, Iowa City

10. Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Clinic, University of Tennessee Health Science Center, Memphis

11. Department of Neurology, Chonnam National University Hospital, Gwangju, Korea

12. Department of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

13. Department of Neurosurgery, University of Texas Medical Branch, Galveston

14. Neuroradiology Department, Hospital São José Centro Hospitalar, Lisboa, Portugal

15. Department of Neurosurgery, University of Florida, Gainesville

16. Department of Neurological Surgery, Washington University in St Louis, St Louis, Missouri

17. Department of Neurosurgery, University of Texas Health Science Center at San Antonio, San Antonio

18. Department of Neurosurgery, University of Washington, Seattle

19. Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania

20. Department of Radiology, A.O.U.S. Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy

21. Department of Neurosurgery, Endovascular Neurological Center, Montevideo, Uruguay

22. Department of Diagnostic and Therapeutic Neuroradiology, Centre Hospitalier Régional Universitaire de Nancy, Nancy, France

23. Department of Neurosurgery, University of South Florida, Tampa

24. Department of Neurology, Indiana University, Indianapolis

25. Department of Cerebrovascular and Endovascular Neurosurgery, Hospital Juan Fernandez, Buenos Aires, Argentina

26. Department of Interventional Neuroradiology, Washington Regional Medical Center, Fayetteville, Arkansas

27. Department of Neurosurgery, University of Utah, Salt Lake City

28. Department of Neurosurgery, Texas Stroke Institute, Plano

29. Department of Neurosurgery, University of Virginia Health, Charlottesville

Abstract

ImportanceThere 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.ObjectiveTo 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 ParticipantsIn 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.ExposuresSelection by NCCT, CTP, or DWI.Main Outcomes and MeasuresPrimary outcome was functional independence (modified Rankin scale 0-2) at 90 days.ResultsAmong 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 RelevanceIn 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.

Publisher

American Medical Association (AMA)

Subject

General Medicine

Link

https://jamanetwork.com/journals/jamanetworkopen/articlepdf/2798324/porto_2022_oi_221166_1667403097.07447.pdf

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