Titre
Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion.
Type
article
Institution
UNIL/CHUV/Unisanté + institutions partenaires
Périodique
Auteur(s)
Nguyen, T.N.
Auteure/Auteur
Abdalkader, M.
Auteure/Auteur
Nagel, S.
Auteure/Auteur
Qureshi, M.M.
Auteure/Auteur
Ribo, M.
Auteure/Auteur
Caparros, F.
Auteure/Auteur
Haussen, D.C.
Auteure/Auteur
Mohammaden, M.H.
Auteure/Auteur
Sheth, S.A.
Auteure/Auteur
Ortega-Gutierrez, S.
Auteure/Auteur
Siegler, J.E.
Auteure/Auteur
Zaidi, S.
Auteure/Auteur
Olive-Gadea, M.
Auteure/Auteur
Henon, H.
Auteure/Auteur
Möhlenbruch, M.A.
Auteure/Auteur
Castonguay, A.C.
Auteure/Auteur
Nannoni, S.
Auteure/Auteur
Kaesmacher, J.
Auteure/Auteur
Puri, A.S.
Auteure/Auteur
Seker, F.
Auteure/Auteur
Farooqui, M.
Auteure/Auteur
Salazar-Marioni, S.
Auteure/Auteur
Kuhn, A.L.
Auteure/Auteur
Kaliaev, A.
Auteure/Auteur
Farzin, B.
Auteure/Auteur
Boisseau, W.
Auteure/Auteur
Masoud, H.E.
Auteure/Auteur
Lopez, C.Y.
Auteure/Auteur
Rana, A.
Auteure/Auteur
Kareem, S.A.
Auteure/Auteur
Sathya, A.
Auteure/Auteur
Klein, P.
Auteure/Auteur
Kassem, M.W.
Auteure/Auteur
Ringleb, P.A.
Auteure/Auteur
Cordonnier, C.
Auteure/Auteur
Gralla, J.
Auteure/Auteur
Fischer, U.
Auteure/Auteur
Michel, P.
Auteure/Auteur
Jovin, T.G.
Auteure/Auteur
Raymond, J.
Auteure/Auteur
Zaidat, O.O.
Auteure/Auteur
Nogueira, R.G.
Auteure/Auteur
Liens vers les personnes
Liens vers les unités
ISSN
2168-6157
Statut éditorial
Publié
Date de publication
2022-01-01
Volume
79
Numéro
1
Première page
22
Dernière page/numéro d’article
31
Peer-reviewed
Oui
Langue
anglais
Notes
Publication types: Journal Article ; Multicenter Study
Publication Status: ppublish
Publication Status: ppublish
Résumé
Advanced imaging for patient selection in mechanical thrombectomy is not widely available.
To compare the clinical outcomes of patients selected for mechanical thrombectomy by noncontrast computed tomography (CT) vs those selected by computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) in the extended time window.
This multinational cohort study included consecutive patients with proximal anterior circulation occlusion stroke presenting within 6 to 24 hours of time last seen well from January 2014 to December 2020. This study was conducted at 15 sites across 5 countries in Europe and North America. The duration of follow-up was 90 days from stroke onset.
Computed tomography with Alberta Stroke Program Early CT Score, CTP, or MRI.
The primary end point was the distribution of modified Rankin Scale (mRS) scores at 90 days (ordinal shift). Secondary outcomes included the rates of 90-day functional independence (mRS scores of 0-2), symptomatic intracranial hemorrhage, and 90-day mortality.
Of 2304 patients screened for eligibility, 1604 patients were included, with a median (IQR) age of 70 (59-80) years; 848 (52.9%) were women. A total of 534 patients were selected to undergo mechanical thrombectomy by CT, 752 by CTP, and 318 by MRI. After adjustment of confounders, there was no difference in 90-day ordinal mRS shift between patients selected by CT vs CTP (adjusted odds ratio [aOR], 0.95 [95% CI, 0.77-1.17]; P = .64) or CT vs MRI (aOR, 0.95 [95% CI, 0.8-1.13]; P = .55). The rates of 90-day functional independence (mRS scores 0-2 vs 3-6) were similar between patients selected by CT vs CTP (aOR, 0.90 [95% CI, 0.7-1.16]; P = .42) but lower in patients selected by MRI than CT (aOR, 0.79 [95% CI, 0.64-0.98]; P = .03). Successful reperfusion was more common in the CT and CTP groups compared with the MRI group (474 [88.9%] and 670 [89.5%] vs 250 [78.9%]; P < .001). No significant differences in symptomatic intracranial hemorrhage (CT, 42 [8.1%]; CTP, 43 [5.8%]; MRI, 15 [4.7%]; P = .11) or 90-day mortality (CT, 125 [23.4%]; CTP, 159 [21.1%]; MRI, 62 [19.5%]; P = .38) were observed.
In patients undergoing proximal anterior circulation mechanical thrombectomy in the extended time window, there were no significant differences in the clinical outcomes of patients selected with noncontrast CT compared with those selected with CTP or MRI. These findings have the potential to widen the indication for treating patients in the extended window using a simpler and more widespread noncontrast CT-only paradigm.
To compare the clinical outcomes of patients selected for mechanical thrombectomy by noncontrast computed tomography (CT) vs those selected by computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) in the extended time window.
This multinational cohort study included consecutive patients with proximal anterior circulation occlusion stroke presenting within 6 to 24 hours of time last seen well from January 2014 to December 2020. This study was conducted at 15 sites across 5 countries in Europe and North America. The duration of follow-up was 90 days from stroke onset.
Computed tomography with Alberta Stroke Program Early CT Score, CTP, or MRI.
The primary end point was the distribution of modified Rankin Scale (mRS) scores at 90 days (ordinal shift). Secondary outcomes included the rates of 90-day functional independence (mRS scores of 0-2), symptomatic intracranial hemorrhage, and 90-day mortality.
Of 2304 patients screened for eligibility, 1604 patients were included, with a median (IQR) age of 70 (59-80) years; 848 (52.9%) were women. A total of 534 patients were selected to undergo mechanical thrombectomy by CT, 752 by CTP, and 318 by MRI. After adjustment of confounders, there was no difference in 90-day ordinal mRS shift between patients selected by CT vs CTP (adjusted odds ratio [aOR], 0.95 [95% CI, 0.77-1.17]; P = .64) or CT vs MRI (aOR, 0.95 [95% CI, 0.8-1.13]; P = .55). The rates of 90-day functional independence (mRS scores 0-2 vs 3-6) were similar between patients selected by CT vs CTP (aOR, 0.90 [95% CI, 0.7-1.16]; P = .42) but lower in patients selected by MRI than CT (aOR, 0.79 [95% CI, 0.64-0.98]; P = .03). Successful reperfusion was more common in the CT and CTP groups compared with the MRI group (474 [88.9%] and 670 [89.5%] vs 250 [78.9%]; P < .001). No significant differences in symptomatic intracranial hemorrhage (CT, 42 [8.1%]; CTP, 43 [5.8%]; MRI, 15 [4.7%]; P = .11) or 90-day mortality (CT, 125 [23.4%]; CTP, 159 [21.1%]; MRI, 62 [19.5%]; P = .38) were observed.
In patients undergoing proximal anterior circulation mechanical thrombectomy in the extended time window, there were no significant differences in the clinical outcomes of patients selected with noncontrast CT compared with those selected with CTP or MRI. These findings have the potential to widen the indication for treating patients in the extended window using a simpler and more widespread noncontrast CT-only paradigm.
PID Serval
serval:BIB_4F2897AF6E8A
PMID
Open Access
Oui
Date de création
2021-11-15T14:33:29.725Z
Date de création dans IRIS
2025-05-20T16:59:40Z
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Nom
34747975_noncontrast computed tomography.pdf
Version du manuscrit
published
Licence
https://creativecommons.org/licenses/by-nc-nd/4.0
Taille
378.99 KB
Format
Adobe PDF
PID Serval
serval:BIB_4F2897AF6E8A.P001
URN
urn:nbn:ch:serval-BIB_4F2897AF6E8A0
Somme de contrôle
(MD5):c55107373d04727678191276d4e31a58