Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion
Nguyen, Thanh N (Boston Medical Center)
Abdalkader, Mohamad (Boston University School of Medicine)
Nagel, Simon (Heidelberg University Hospital (Alemanya))
Qureshi, Muhammad M. (Boston University School of Medicine)
Ribo, Marc (Hospital Universitari Vall d'Hebron)
Caparros, Francois (University Lille (Lille, França))
Haussen, Diogo C. (Emory University School of Medicine (Atlanta, Estats Units d'Amèrica))
Mohammaden, Mahmoud H. (Emory University School of Medicine (Atlanta, Estats Units d'Amèrica))
Sheth, Sunil A. (McGovern Medical School at UTHealth (Houston, Estats Units d'Amèrica))
Ortega-Gutierrez, Santiago (University of Iowa)
Siegler, James E. (Cooper University Hospital (Camden, Estats Units d'Amèrica))
Zaidi, Syed (University of Toledo (Toledo Ohio, Estats Units d'Amèrica))
Olivé-Gadea, Marta (Hospital Universitari Vall d'Hebron)
Henon, Hilde (University Lille (Lille, França))
Möhlenbruch, Markus A. (Heidelberg University Hospital (Alemanya))
Castonguay, Alicia C. (University of Toledo (Toledo Ohio, Estats Units d'Amèrica))
Nannoni, Stefania (Lausanne University Hospital (Lausanne, Switzerland))
Kaesmacher, Johannes (University Hospital Bern)
Puri, Ajit S. (University of Massachusetts)
Seker, Fatih (Heidelberg University Hospital (Alemanya))
Farooqui, Mudassir (University of Iowa (Iowa, USA))
Salazar-Marioni, Sergio (McGovern Medical School at UTHealth (Houston, Estats Units d'Amèrica))
Kuhn, Anna L. (University of Massachusetts)
Kaliaev, Artem (Boston University School of Medicine)
Farzin, Behzad (Centre Hospitalier de l'Université de Montréal)
Boisseau, William (Centre Hospitalier de l'Université de Montréal)
Masoud, Hesham E. (SUNY Upstate Medical University Hospital)
Lopez, Carlos Ynigo (SUNY Upstate Medical University Hospital)
Rana, Ameena (Cooper University Hospital (Camden, Estats Units d'Amèrica))
Kareem, Samer Abdul (Bon Secours Mercy Health St Vincent Hospital)
Sathya, Anvitha (Boston University School of Medicine)
Klein, Piers (Boston University School of Medicine)
Kassem, Mohammad W. (Bon Secours Mercy Health St Vincent Hospital)
Ringleb, Peter A. (Heidelberg University Hospital (Alemanya))
Cordonnier, Charlotte (Centre Hospitalier Universitaire de Lille)
Gralla, Jan (University Hospital Bern)
Fischer, Urs (University Hospital Basel (Basilea, Suïssa))
Michel, Patrik (Lausanne University Hospital (Lausanne, Switzerland))
Jovin, Tudor G. (Cooper University Hospital (Camden, Estats Units d'Amèrica))
Raymond, Jean (Centre Hospitalier de l'Université de Montréal)
Zaidat, Osama (Bon Secours Mercy Health St Vincent Hospital)
Nogueira, Raul G. (Emory University School of Medicine (Atlanta, Estats Units d'Amèrica))
Universitat Autònoma de Barcelona

Data:	2021
Resum:	In patients with proximal anterior circulation occlusion stroke presenting in the extended window, are rates of favorable outcomes at 90 days comparable in the patients selected for thrombectomy with noncontrast computed tomography vs patients selected with computed tomography perfusion or magnetic resonance imaging? In a multicenter cohort of 1604 patients in the extended window with large-vessel occlusion, patients selected by noncontrast computed tomography had comparable clinical and safety outcomes with patients selected by computed tomography perfusion or magnetic resonance imaging. These findings suggest noncontrast computed tomography alone may be used as an alternative to advanced imaging in selecting patients with late-presenting large-vessel occlusion for mechanical thrombectomy. This cohort study compares the clinical outcomes of patients with stroke who presented 6 to 24 hours after symptom onset and were selected for mechanical thrombectomy by noncontrast computed tomography vs those selected by computed tomography perfusion or magnetic resonance imaging. 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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, i la comunicació pública de l'obra, sempre que no sigui amb finalitats comercials, i sempre que es reconegui l'autoria de l'obra original. No es permet la creació d'obres derivades.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Publicat a:	JAMA Neurology, Vol. 79 (november 2021) , p. 1-10, ISSN 2168-6157

DOI: 10.1001/jamaneurol.2021.4082
PMID: 34747975

21 p, 798.3 KB

El registre apareix a les col·leccions:
Articles > Articles de recerca
Articles > Articles publicats