AI Article Synopsis
- The study aimed to determine the best imaging methods (NCCT/CTA vs. CTP or MRI) for selecting patients for endovascular thrombectomy (EVT) in late-stage acute ischemic stroke caused by large vessel occlusions.
- After reviewing relevant studies, the findings indicated no significant differences in independence rates at 90 days or discharge and in the occurrence of symptomatic intracranial hemorrhage between the imaging groups, but higher mortality was observed in patients chosen by NCCT/CTA.
- The conclusion suggests that using NCCT/CTA for initial selection may still be effective for patient triage in late-window AIS-LVO cases, despite the increased risk of mortality.
Article Abstract
Purpose: Optimal imaging modalities to select patients for endovascular thrombectomy (EVT) in the late window of acute ischemic stroke due to large vessel occlusions (AIS-LVO) are not known. We conducted a systematic review comparing outcomes of patients selected by non-contrast computed tomography (NCCT)/CT angiography (CTA) vs. those selected by CT perfusion (CTP) or magnetic resonance imaging (MRI) for EVT in these patients.
Methods: We searched PUBMED, EMBASE, and the Cochrane Library from January 1, 2000, to July 15, 2023, to identify studies comparing outcomes of patients selected for EVT by NCCT/CTA vs. CTP or MRI in the late time window for AIS-LVO. Primary outcome was independence (mRS 0-2) at 90 days or discharge. Secondary outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. We pooled data across studies based on an inverse variance method.
Results: Six cohort studies with 4208 patients were included. Pooled results showed no significant difference in the rate of independence at 90 days or discharge (RR 0.96, 95% CI 0.88-1.03) and sICH (RR 1.26, 0.85-1.86) between patients selected by NCCT/CTA vs. CTP or MRI for EVT in the late window of AIS-LVO. However, patients selected by NCCT/CTA vs. CTP or MRI for EVT were associated with a higher risk of mortality (RR 1.21, 1.06-1.39).
Conclusion: For AIS-LVO in the late window, patients selected by NCCT/CTA compared with those selected by CTP or MRI for EVT might have a comparable rate of functional independence and sICH. Baseline NCCT/CTA may triage AIS-LVO in the late window.
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| http://dx.doi.org/10.1007/s00234-024-03324-z | DOI Listing |
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