Raul G Nogueira1, Diogo C Haussen1, David Liebeskind2, Tudor G Jovin3, Rishi Gupta4, Ashutov Jadhav5, Ron F Budzik6, Blaise Baxter7, Antonin Krajina8, Alain Bonafe9, Ali Malek10, Ana Paula Narata11, Ryan Shields12, Yanchang Zhang12, Patricia Morgan12, Bruno Bartolini13, Joey English14, Michael R Frankel1, Erol Veznedaroglu15. 1. Department of Neurology, Emory University School of Medicine, Marcus Stroke & Neuroscience Center, Grady Memorial Hospital, Atlanta, GA (R.G.N., D.C.H., M.R.F.). 2. Department of Neurology, UCLA, Los Angeles, CA (D.L.). 3. Department of Neurology, Cooper University Hospital Neurological Institute, Camden, NJ (T.G.J.). 4. Department of Neurosciences, Wellstar Health System, Atlanta, GA (R.G.). 5. Department of Neurology, Stroke Institute, University of Pittsburgh Medical Center, PA (A.J.). 6. Department of Interventional Neuroradiology, Riverside Methodist Hospital/Ohio Health Research Institute, Columbus (R.F.B.). 7. Department of Radiology, Erlanger Hospital, Chattanooga, TN (B. Baxter). 8. Department of Radiology, University Hospital Hradec Kralove, Czech Republic (A.K.). 9. Department of Neuroradiology, CHU Montpellier, France (A.B.). 10. St. Mary's Medical Center, West Palm Beach, FL (A.M.). 11. Department of Neuroradiology, CHU Tours, France (A.P.N.). 12. Stryker Neurovascular, Fremont, CA (R.S., Y.Z., P.M.). 13. Department of Interventional Radiology, La Pitie Salpetriere, Paris, France (B. Bartolini). 14. Department of Neurology, California Pacific Medical Center, San Francisco (J.E.). 15. Department of Neurosciences, Drexel Neurosciences Institute, Philadelphia, PA (E.V.).
Abstract
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.
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.
Authors: Robert W Regenhardt; R Gilberto González; Julian He; Michael H Lev; Aneesh B Singhal Journal: Radiology Date: 2021-11-02 Impact factor: 11.105
Authors: Luuk Dekker; Esmee Venema; F Anne V Pirson; Charles B L M Majoie; Bart J Emmer; Ivo G H Jansen; Maxim J H L Mulder; Robin Lemmens; Robert-Jan B Goldhoorn; Marieke J H Wermer; Jelis Boiten; Geert J Lycklama À Nijeholt; Yvo B W E M Roos; Adriaan C G M van Es; Hester F Lingsma; Diederik W J Dippel; Wim H van Zwam; Robert J van Oostenbrugge; Ido R van den Wijngaard Journal: Stroke Vasc Neurol Date: 2021-04-07
Authors: Moriz Herzberg; Korbinian Scherling; Robert Stahl; Steffen Tiedt; Frank A Wollenweber; Clemens Küpper; Katharina Feil; Robert Forbrig; Maximilian Patzig; Lars Kellert; Wolfgang G Kunz; Paul Reidler; Hanna Zimmermann; Thomas Liebig; Marianne Dieterich; Franziska Dorn Journal: Clin Neuroradiol Date: 2021-06-07 Impact factor: 3.649