Stroke imaging prior to thrombectomy in the late window: results from a pooled multicentre analysis

• Published in: Journal of neurology, neurosurgery and psychiatry Vol. 93; no. 5; pp. 468 - 474
• Main Authors: Almekhlafi, Mohammed A, Thornton, John, Casetta, Ilaria, Goyal, Mayank, Nannoni, Stefania, Herlihy, Darragh, Fainardi, Enrico, Power, Sarah, Saia, Valentina, Hegarty, Aidan, Pracucci, Giovanni, Demchuk, Andrew, Mangiafico, Salvatore, Boyle, Karl, Michel, Patrik, Bala, Fouzi, Gill, Rubina, Kuczynski, Andrea, Ademola, Ayolla, Hill, Michael D, Toni, Danilo, Murphy, Sean, Kim, Beom Joon, Menon, Bijoy K
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd 01.05.2022; BMJ Publishing Group LTD
• Subjects: Brain Ischemia - diagnostic imaging; Brain Ischemia - surgery; cerebrovascular; Cerebrovascular disease; Computed Tomography Angiography - methods; Consortia; Endovascular Procedures - methods; Humans; image analysis; interventional; Ischemia; Ischemic Stroke; Paradigms; Patients; Stroke; Stroke - diagnostic imaging; Stroke - etiology; Stroke - surgery; Thrombectomy - adverse effects; Treatment Outcome; cerebrovascular; image analysis; interventional; stroke
• ISSN: 0022-3050; 1468-330X
• DOI: 10.1136/jnnp-2021-327959

Background and purposeCollateral assessment using CT angiography is a promising modality for selecting patients for endovascular thrombectomy (EVT) in the late window (6–24 hours). The outcome of these patients compared with those selected using perfusion imaging is not clear.MethodsWe pooled data from seven trials and registries of EVT-treated patients in the late-time window. Patients were classified according to the baseline imaging into collateral imaging alone (collateral cohort) and perfusion plus collateral imaging (perfusion cohort). The primary outcome was the proportion of patients achieving independent 90-day functional outcome (modified Rankin Scale ‘mRS’ 0–2). We used the propensity score–weighting method to balance important predictors between the cohorts.ResultsIn 608 patients, the median onset/last-known-well to emergency arrival time was 8.8 hours and 53.2% had wake-up strokes. Both cohorts had collateral imaging and 379 (62.3%) had perfusion imaging. Independent functional outcome was achieved in 43.1% overall: 168/379 patients (45.5%) in the perfusion cohort versus 94/214 (43.9%) in the collateral cohort (p=0.71). A logistic regression model adjusting for inverse-probability-weighting showed no difference in 90-day mRS score of 0–2 among the perfusion versus collateral cohorts (adjusted OR 1.05, 95% CI 0.69 to 1.59, p=0.83) or in a favourable shift in 90-day mRS (common adjusted OR 1.01, 95% CI 0.69 to 1.47, p=0.97).ConclusionThis pooled analysis of late window EVT showed comparable functional outcomes in patients selected for EVT using collateral imaging alone compared with patients selected using perfusion and collateral imaging.PROSPERO registration numberCRD42020222003.