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Guilherme B. F. Porto, MD, Departments of Neurosurgery and Neuroendovascular Surgery, Medical University of South Carolina, 96 Jonathan Lucas St, Charleston, SC 29425. Email: porto@musc.edu

Drs Porto and Essibayi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Concept and design: Porto, Chen, Al Kasab, Almallouhi, Chalhoub, Alawieh, Psychogios, Starke, Kan, Yoo, Spiotta. Acquisition, analysis, or interpretation of data: Porto, Chen, Amir Essibayi, Almallouhi, Hubbard, Chalhoub, Alawieh, Maier, Wolfe, Jabbour, Rai, Starke, Shaban, Arthur, Kim, Yoshimura, Grossberg, Kan, Fragata, Polifka, Osbun, Mascitelli, Levitt, Williamson, Romano, Crosa, Gory, Mokin, Limaye, Casagrande, Moss, Grandhi, Yoo, Spiotta, Park. Drafting of the manuscript: Porto, Al Kasab, Amir Essibayi, Starke, Casagrande. Critical revision of the manuscript for important intellectual content: Porto, Chen, Al Kasab, Almallouhi, Hubbard, Chalhoub, Alawieh, Maier, Psychogios, Wolfe, Jabbour, Rai, Starke, Shaban, Arthur, Kim, Yoshimura, Grossberg, Kan, Fragata, Polifka, Osbun, Mascitelli, Levitt, Williamson, Romano, Crosa, Gory, Mokin, Limaye, Moss, Grandhi, Yoo, Spiotta, Park. Statistical analysis: Chen, Amir Essibayi, Chalhoub. Obtained funding: Casagrande, Spiotta. Administrative, technical, or material support: Porto, Hubbard, Alawieh, Maier, Wolfe, Starke, Grossberg, Kan, Levitt, Williamson, Mokin, Spiotta. Supervision: Porto, Chen, Al Kasab, Almallouhi, Psychogios, Jabbour, Starke, Shaban, Grossberg, Osbun, Grandhi, Park

The authors thank Meredith Robinson, MS, and Anna Bisig, MS (Medical University of South Carolina), for their assistance with maintenance of registry database and data collection management. Neither contributor was compensated beyond their normal salary for their contribution. Written permission to include their names was obtained.

Dr Chalhoub reported receiving grants from Stryker (Medical University of South Carolina [MUSC]), Medtronic (MUSC), RAPID (MUSC), and Penumbra (MUSC) during the conduct of the study. Dr Jabbour reported receiving consulting fees from Balt, Cerus Endovascular, MicroVention, and Medtronic outside the submitted work. Dr Rai reported receiving personal fees from Stryker Neurovascular and Cerenovus outside the submitted work. Dr Starke reported receiving grants from the National Institutes of Health; and consulting fees from Medtronic, Penumbra, Cerenovus, Balt, InNeuroCo, Optimize Vascular, and Abbott outside the submitted work. Dr Arthur reported receiving personal fees from Balt, Cerenovus, Medtronic, Microvention, Penumbra, Perfuze, Siemens, and Stryker; consulting fees from Arsenal, Balt, Johnson & Johnson, Medtronic, Microvention, Penumbra, Scientia, Siemens, and Stryker; and being a shareholder at Bendit, Cerebrotech, Magneto, Vastrax, and VizAI outside the submitted work. Dr Yoshimura reported receiving personal fees from Stryker, Medtronic, Johnson & Johnson, Kaneka Medics, Terumo, and Biomedical Solutions during the conduct of the study; personal fees from Boehringer-Ingelheim, Daiichi Sankyo, Bayer, and Bristol-Myers Squibb outside the submitted work. Dr Grossberg reported receiving grants from Emory Medical Care Foundation, Neurosurgery Catalyst, and Georgia Research Alliance, and being a consultant with stock options at Cognition Medical outside the submitted work. Dr Kan reported receiving personal fees from Stryker Neurovascular Consulting, Imperative Care Consulting, Cerenovus Consulting, and Microvention Consulting outside the submitted work. Dr Polifka reported receiving consulting fees from Stryker and Depuy Synthes outside the submitted work. Dr Osbun reported receiving personal fees from Medtronic, Stryker, Terumo, Microvention, Penumbra, and InNeuroCo outside the submitted work. Dr Mascitelli reported receiving consulting fees from Stryker outside the submitted work. Dr Levitt reported receiving grants from Medtronic and Stryker; equity interest from Proprio, Cerebrotech, Synchron, Hyperion Surgical, and Apertur; financial interest from Fluid Biomed; consulting fees from Metis Innovative Adviser; and support for meetings and travel from Penumbra; serving as an adviser to Aeaean; and clinical support from Stryker Neurovascular and Medtronic outside the submitted work. Dr Romano reported receiving consulting fees from Penumbra INC, Microvention Europe, Balt International, and Balt Italy outside the submitted work. Dr Mokin reported being a consultant for Cerenovus, Medtronic, and Microvention and receiving stock options from Bendit Technologies, BrainQ, Endostream, Serenity Medical, Synchros, Sim&Cure, QAS.AI, and Quantanosis.AI outside the submitted work. Dr Grandhi reported receiving consulting fees from Medtronic Neurovascular, Cerenovus, and Balt Neurovascular outside the submitted work. Dr Yoo reported receiving consulting fees from Cerenovus, Penumbra, National Institutes of Health/National Institute of Neurological Disorders and Stroke, Vesalio, Zoll Circulation; grants from Cerenovus, Penumbra, Medtronic, Stryker, Genentech; clinical support from Vesalio and Zoll Circulation; personal fees from Cerenovus, Penumbra, Philips Neurovascular; and equity interest from Insera Therapeutics and Nicolab outside the submitted work. Dr Spiotta reported receiving Stroke Thrombectomy and Aneurysm Registry financial and nonfinancial support from RapidAI, Medtronic, Stryker Neurovascular, Penumbra, and Avail; research grants from Medtronic, Stryker Neurovascular, and Penumbra; and consulting services from Stryker Neurovascular, Penumbra, RapidAI, and Terumo outside the submitted work. No other disclosures were reported.

Subject:

Research Funding:

STAR receives financial support from RapidAI, Medtronic, Stryker Neurovascular, Penumbra, and Avail for maintenance of research database.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Medicine, General & Internal
  • General & Internal Medicine
  • EARLY CT SCORE
  • ISCHEMIC-STROKE
  • ALBERTA STROKE
  • VOLUME
  • CORE
  • REPERFUSION
  • SELECTION

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

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Journal Title:

JAMA NETWORK OPEN

Volume:

Volume 5, Number 11

Publisher:

, Pages E2241291-E2241291

Type of Work:

Article | Final Publisher PDF

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.

Copyright information:

2022 Porto GBF et al. JAMA Network Open.

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/).
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