Comparison Between Perfusion- and Collateral-Based Triage for Endovascular Thrombectomy in a Late Time Window

• Published in: Stroke (1970) Vol. 50; no. 12; pp. 3465 - 3470
• Main Authors: Kim, Byungjun, Jung, Cheolkyu, Nam, Hyo Suk, Kim, Byung Moon, Kim, Young Dae, Heo, Ji Hoe, Kim, Dong Joon, Kim, Jun-Hwee, Han, Kyunghwa, Kim, Jae Hyoung, Kim, Beom Joon
• Format: Journal Article
• Language: English
• Published: United States American Heart Association, Inc 01.12.2019
• Subjects: Aged; Aged, 80 and over; Cerebral Angiography - methods; Cerebral Infarction - diagnostic imaging; Cerebral Infarction - therapy; Collateral Circulation - physiology; Computed Tomography Angiography - methods; Endovascular Procedures - methods; Female; Humans; Male; Middle Aged; Neuroimaging - methods; Perfusion - methods; Thrombectomy - methods; Time-to-Treatment; Tomography, X-Ray Computed - methods; Triage - methods; computed tomography angiography; perfusion; outcome and process assessment (health care); humans; thrombectomy
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/STROKEAHA.119.027216

BACKGROUND AND PURPOSE—Perfusion-based triage has proven to be effective and safe for selecting patients who are likely to benefit from endovascular thrombectomy (EVT) in a late time window. We investigated collateral-based triage for EVT in patients presenting beyond 6 hours, in terms of interrater reliability and efficacy in predicting clinical outcome, in comparison to perfusion-based triage. METHODS—One hundred and thirty-two patients who underwent both computed tomographic angiography and computed tomography perfusion for anterior circulation large artery occlusion 6 to 24 hours after last seen well were enrolled. Patients were classified into EVT-eligible and EVT-ineligible groups according to perfusion- and collateral-based triages. We evaluated the interrater reliability of collateral-based triage and differences in good outcome rates of patients who received EVT in the EVT-eligible groups based on perfusion- and collateral-based triages. RESULTS—Both computed tomographic angiography and computed tomography perfusion were assessable in 93 patients. Seventy-six patients were eligible for EVT according to perfusion-based triage. Among them, EVT was performed in 58, of whom 32 (55.1%) had good outcome. Sixty-nine patients were eligible for EVT based on collateral-based triage. Among them, EVT was performed in 50 patients, of whom 31 (62.0%) had good outcome. Interrater reliability of collateral-based triage was good (generalized κ=0.73 [95% CI, 0.59–0.84]). Agreement on EVT eligibility between perfusion- and collateral-based triages was moderate (κ=0.41 [95% CI, 0.16–0.61]). There was no difference in good outcome rates of patients who underwent EVT in the EVT-eligible groups based on perfusion- and collateral-based triages (55.1% versus 62.0%; P=0.0675). CONCLUSIONS—Collateral-based triage showed good interrater reliability and comparable efficacy to that of perfusion-based triage in predicting clinical outcome after EVT in patients presenting beyond 6 hours. Collateral-based triage is a reliable approach for selecting patients for EVT in the extended therapeutic time window.