Effect of Imaging Selection Paradigms on Endovascular Thrombectomy Outcomes in Patients With Acute Ischemic Stroke

被引：20

作者：

Miao, Jian ^{[1
,2
,3
]}

Sang, Hongfei ^{[4
]}

Li, Fengli ^{[2
,3
]}

Saver, Jeffrey L. ^{[5
]}

Lei, Bo ^{[6
]}

Li, Jinglun ^{[7
]}

Nogueira, Raul Gomes ^{[8
]}

Song, Bo ^{[1
]}

Liu, Shudong ^{[9
]}

Nguyen, Thanh N. ^{[10
]}

Jin, Zhenglong ^{[11
]}

Zeng, Hongliang ^{[12
]}

Wen, Changming ^{[13
]}

Yuan, Guangxiong ^{[14
]}

Kong, Weilin ^{[2
,3
]}

Luo, Weidong ^{[15
]}

Liu, Shuai ^{[2
,3
]}

Xie, Dongjing ^{[2
,3
]}

Huang, Jiacheng ^{[2
,3
]}

Liu, Chang ^{[16
]}

Yang, Jie ^{[2
,3
]}

Hu, Jinrong ^{[2
,3
]}

Song, Jiaxing ^{[2
,3
]}

Yue, Chengsong ^{[2
,3
]}

Li, Linyu ^{[2
,3
]}

Tian, Yan ^{[2
,3
]}

Zhang, Xiao ^{[17
]}

Feng, Dan ^{[1
]}

Gao, Yani ^{[1
]}

Fu, Huiying ^{[1
]}

Zi, Wenjie ^{[2
,3
]}

Yang, Qingwu ^{[2
,3
]}

Qiu, Zhongming ^{[18
,19
]}

Wang, Shaojun ^{[1
]}

机构：

[1] Yanan Univ, Neurol, Xianyang Hosp, Yanan, Peoples R China

[2] Third Military Med Univ, Army Med Univ, Xinqiao Hosp, Neurol, Chongqing, Peoples R China

[3] Army Med Univ, Affiliated Hosp 2, Third Mil Med Univ, Chongqing, Peoples R China

[4] Zhejiang Univ, Affiliated Hangzhou Peoples Hosp 1, Neurol, Sch Med, Hangzhou, Peoples R China

[5] UCLA, Neurol, David Geffen Sch Med, Los Angeles, CA USA

[6] Leshan Peoples Hosp, Cerebrovasc Dis, Leshan, Peoples R China

[7] Southwest Med Univ, Neurol, Affiliated Hosp, Luzhou, Peoples R China

[8] Univ Pittsburgh, UPMC Stroke Inst, Sch Med, Pittsburgh, PA USA

[9] Chongqing Med Univ, Chongqing Key Lab Cerebrovasc Dis Res, Neurol, Yongchuan Hosp, Chongqing, Peoples R China

[10] Boston Med Ctr, Neurol, Boston, MA USA

[11] Wuyi Hosp Tradit Chinese Med, Neurol, Jiangmen, Peoples R China

[12] Ganzhou Peoples Hosp, Neurol, Guangzhou, Peoples R China

[13] Nanyang Cent Hosp, Neurol, Nanyang, Peoples R China

[14] Xiangtan Cent Hosp, Emergency, Xiangtan, Peoples R China

[15] Gen Hosp Tibet Mil Area Command, Neurol, Lhasa, Peoples R China

[16] Chongqing Med Univ, Neurol, Affiliated Hosp 2, Chongqing, Peoples R China

[17] Northwest Univ, Xian Hosp 3, Neurol, Affiliated Hosp, Xian, Peoples R China

[18] 903rd Hosp Peoples Liberat Army, Neurol, Hangzhou, Peoples R China

[19] 903rd Hosp Peoples Liberat Army, Hangzhou, Peoples R China

来源：

STROKE | 2023年 / 54卷 / 06期

基金：

中国国家自然科学基金;

关键词：

ischemic stroke; patient selection; perfusion; thrombectomy; tomography; 2019; UPDATE; GUIDELINES; TIME; MANAGEMENT; CORE;

D O I：

10.1161/STROKEAHA.122.042203

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND The effect of imaging selection paradigms on endovascular thrombectomy outcomes in patients with acute ischemic stroke with large vessel occlusion remains uncertain. The study aimed to assess the effect of basic imaging (noncontrast computed tomography with or without computed tomographic angiography) versus advanced imaging (magnetic resonance imaging or computed tomography perfusion) on clinical outcomes following thrombectomy in patients with stroke with large vessel occlusion in the early and extended windows using a pooled analysis of patient-level data from 2 pivotal randomized clinical trials done in China.METHODS This post hoc analysis used data from 1182 patients included in 2 multicenter, randomized controlled trials in China that evaluated adjunct therapies to endovascular treatment for acute ischemic stroke (Direct Endovascular Treatment for Large Artery Anterior Circulation Stroke performed from May 20, 2018, through May 2, 2020, and Intravenous Tirofiban Before Endovascular Treatment in Stroke from October 10, 2018, through October 31, 2021). Patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery (M1/M2 segments) were categorized according to baseline imaging modality (basic versus advanced) as well as treatment time window (early, 0-6 hours versus extended, 6-24 hours from last known well to puncture). The primary outcome was the proportion of patients with functional independence (modified Rankin Scale score of 0-2) at 90 days. Multivariable Poisson regression analysis was performed to determine the association between imaging selection modality and outcomes after endovascular treatment at each time windows.RESULTS A total of 1182 patients were included in this cohort analysis, with 648 in the early (471 with basic imaging versus 177 advanced imaging) and 534 in the extended (222 basic imaging versus 312 advanced imaging) time window. There were no differences in 90-day functional independence between the advanced and basic imaging groups in either time windows (early window: adjusted relative risk, 0.99 [95% CI, 0.84-1.16]; P=0.91; extended window: adjusted relative risk, 1.00 [95% CI, 0.84-1.20]; P=0.97).CONCLUSIONS In this post hoc analysis of 2 randomized clinical trial pooled data involving patients with large vessel occlusion stroke, an association between imaging selection modality and clinical or safety outcomes for patients undergoing thrombectomy in either the early or extended windows was not detected. Our study adds to the growing body of literature on simpler imaging paradigms to assess thrombectomy eligibility across both the early and extended time windows.

引用

页码：1569 / 1577

页数：9

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