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Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows
Journal article   Open access   Peer reviewed

Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows

Raul G. Nogueira, Diogo C. Haussen, David Liebeskind, Tudor G. Jovin, Rishi Gupta, Ashutov Jadhav, Ron F. Budzik, Blaise Baxter, Antonin Krajina, Alain Bonafe, …
Stroke (1970), v 52(2), pp 491-497
01 Feb 2021
DOI: https://doi.org/10.1161/STROKEAHA.120.031685
PMID: 33430634
Featured in Collection :   UN Sustainable Development Goals @ Drexel
url
https://doi.org/10.1161/strokeaha.120.031685View
Published, Version of Record (VoR)Maybe Open Access (Publisher Bronze),  Open

Abstract

Cardiovascular System & Cardiology Clinical Neurology Life Sciences & Biomedicine Neurosciences & Neurology Peripheral Vascular Disease Science & Technology
Background and Purpose: Advanced imaging has been increasingly used for patient selection in endovascular stroke therapy. The impact of imaging selection modality on endovascular stroke therapy clinical outcomes in extended time window remains to be defined. We aimed to study this relationship and compare it to that noted in early-treated patients. Methods: Patients from a prospective multicentric registry (n=2008) with occlusions involving the intracranial internal carotid or the M1- or M2-segments of the middle cerebral arteries, premorbid modified Rankin Scale score 0 to 2 and time to treatment 0 to 24 hours were categorized according to treatment times within the early (0-6 hour) or extended (6-24 hour) window as well as imaging modality with noncontrast computed tomography (NCCT)+/- CT angiography (CTA) or NCCT +/- CTA and CT perfusion (CTP). The association between imaging modality and 90-day modified Rankin Scale, analyzed in ordinal (modified Rankin Scale shift) and dichotomized (functional independence, modified Rankin Scale score 0-2) manner, was evaluated and compared within and across the extended and early windows. Results: In the early window, 332 patients were selected with NCCT +/- CTA alone while 373 also underwent CTP. After adjusting for identifiable confounders, there were no significant differences in terms of 90-day functional disability (ordinal shift: adjusted odd ratio [aOR], 0.936 [95% CI, 0.709-1.238], P=0.644) or independence (aOR, 1.178 [95% CI, 0.833-1.666], P=0.355) across the CTP and NCCT +/- CTA groups. In the extended window, 67 patients were selected with NCCT +/- CTA alone while 180 also underwent CTP. No significant differences in 90-day functional disability (aOR, 0.983 [95% CI, 0.81-1.662], P=0.949) or independence (aOR, 0.640 [95% CI, 0.318-1.289], P=0.212) were seen across the CTP and NCCT +/- CTA groups. There was no interaction between the treatment time window (0-6 versus 6-24 hours) and CT selection modality (CTP versus NCCT +/- CTA) in terms of functional disability at 90 days (P=0.45). Conclusions: CTP acquisition was not associated with better outcomes in patients treated in the early or extended time windows. While confirmatory data is needed, our data suggests that extended window endovascular stroke therapy may remain beneficial even in the absence of advanced imaging.

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63 citations in Web of Science
55 citations in Scopus

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UN Sustainable Development Goals (SDGs)

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#3 Good Health and Well-Being

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Collaboration types
Domestic collaboration
International collaboration
Web of Science research areas
Clinical Neurology
Peripheral Vascular Disease
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