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

• Type of Material: Article
• Authors: Guilherme BF Porto, Medical University of South Carolina; Ching-Jen Chen, Thomas Jefferson University; Sami Al Kasab, Medical University of South Carolina; Muhammed A Essibayi, Medical University of South Carolina; Eyad Almallouhi, Medical University of South Carolina; Zachary Hubbard, Medical University of South Carolina; Reda Chalhoub, Medical University of South Carolina; Ali Alawieh, Emory University; Ilko Maier, University Medical Center Göttingen; Marios-Nikos Psychogios, University of Basel; Stacey Q Wolfe, Wake Forest University; Pascal Jabbour, Thomas Jefferson University; Ansaar Rai, West Virginia University; Robert M Starke, University of Miami Health System; Amir Shaban, University of Iowa; Adam Arthur, Univ Tennessee; Joon-Tae Kim, Chonnam National University Hospital; Shinchi Yoshimura, Hyogo College of Medicine; Jonathan Grossberg, Emory University; Peter Kan, University of Texas Medical Branch; Isabel Fragata, Hospital São José Centro Hospitalar; Adam Polifka, University of Florida; Joshua Osbun, Washington University in St. Louis; Justin Mascitelli, University of Texas Health Science Center at San Antonio; Michael R Levitt, University of Washington; Richard Williamson Jr, Allegheny Hlth Network; Daniele G Romano, AOUS Giovanni Dio & Ruggi dAragona; Roberto Crosa, Endovasc Neurol Ctr; Benjamin Gory, Ctr Hosp Reg Univ Nancy; Maxim Mokin, University of South Florida; Kaustubh S Limaye, Indiana University; Walter Casagrande, Hospital Juan Fernandez; Mark Moss, Washington Regional Medical Center; Ramesh Grandhi, University of Utah; Albert Yoo, Texas Stroke Inst; Alejandro M Spiotta, Medical University of South Carolina; Min S Park, University of Virginia Health
• Language: English
• Date: 2022-11-11
• Publisher: AMER MEDICAL ASSOC
• Publication Version: Final Published Version
• Copyright Statement: 2022 Porto GBF et al. JAMA Network Open.
• License: Creative Commons Attribution 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1001/jamanetworkopen.2022.41291
• Title of Journal or Parent Work: JAMA NETWORK OPEN
• Volume: 5
• Issue: 11
• Start Page: E2241291
• End Page: E2241291
• Grant/Funding Information: STAR receives financial support from RapidAI, Medtronic, Stryker Neurovascular, Penumbra, and Avail for maintenance of research database.
• Keywords: REPERFUSION; Science & Technology; CORE; VOLUME; ISCHEMIC-STROKE; Medicine, General & Internal; General & Internal Medicine; Life Sciences & Biomedicine; SELECTION; EARLY CT SCORE; ALBERTA STROKE
• Research Categories: Health Sciences, Medicine and Surgery

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.