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

作者全名："Miao, Jian; Sang, Hongfei; Li, Fengli; Saver, Jeffrey L.; Lei, Bo; Li, Jinglun; Nogueira, Raul Gomes; Song, Bo; Liu, Shudong; Nguyen, Thanh N.; Jin, Zhenglong; Zeng, Hongliang; Wen, Changming; Yuan, Guangxiong; Kong, Weilin; Luo, Weidong; Liu, Shuai; Xie, Dongjing; Huang, Jiacheng; Liu, Chang; Yang, Jie; Hu, Jinrong; Song, Jiaxing; Yue, Chengsong; Li, Linyu; Tian, Yan; Zhang, Xiao; Feng, Dan; Gao, Yani; Fu, Huiying; Zi, Wenjie; Yang, Qingwu; Qiu, Zhongming; Wang, Shaojun"

作者地址："[Miao, Jian; Song, Bo; Feng, Dan; Gao, Yani; Fu, Huiying; Wang, Shaojun] Yanan Univ, Neurol, Xianyang Hosp, Yanan, Peoples R China; [Miao, Jian; Li, Fengli; Kong, Weilin; Liu, Shuai; Xie, Dongjing; Huang, Jiacheng; Yang, Jie; Hu, Jinrong; Song, Jiaxing; Yue, Chengsong; Li, Linyu; Tian, Yan; Zi, Wenjie; Yang, Qingwu] Third Military Med Univ, Army Med Univ, Xinqiao Hosp, Neurol, Chongqing, Peoples R China; [Miao, Jian; Li, Fengli; Kong, Weilin; Liu, Shuai; Xie, Dongjing; Huang, Jiacheng; Yang, Jie; Hu, Jinrong; Song, Jiaxing; Yue, Chengsong; Li, Linyu; Tian, Yan; Zi, Wenjie; Yang, Qingwu] Army Med Univ, Affiliated Hosp 2, Third Mil Med Univ, Chongqing, Peoples R China; [Sang, Hongfei] Zhejiang Univ, Affiliated Hangzhou Peoples Hosp 1, Neurol, Sch Med, Hangzhou, Peoples R China; [Saver, Jeffrey L.] UCLA, Neurol, David Geffen Sch Med, Los Angeles, CA USA; [Lei, Bo] Leshan Peoples Hosp, Cerebrovasc Dis, Leshan, Peoples R China; [Li, Jinglun] Southwest Med Univ, Neurol, Affiliated Hosp, Luzhou, Peoples R China; [Nogueira, Raul Gomes] Univ Pittsburgh, UPMC Stroke Inst, Sch Med, Pittsburgh, PA USA; [Liu, Shudong] Chongqing Med Univ, Chongqing Key Lab Cerebrovasc Dis Res, Neurol, Yongchuan Hosp, Chongqing, Peoples R China; [Nguyen, Thanh N.] Boston Med Ctr, Neurol, Boston, MA USA; [Jin, Zhenglong] Wuyi Hosp Tradit Chinese Med, Neurol, Jiangmen, Peoples R China; [Zeng, Hongliang] Ganzhou Peoples Hosp, Neurol, Guangzhou, Peoples R China; [Wen, Changming] Nanyang Cent Hosp, Neurol, Nanyang, Peoples R China; [Yuan, Guangxiong] Xiangtan Cent Hosp, Emergency, Xiangtan, Peoples R China; [Luo, Weidong] Gen Hosp Tibet Mil Area Command, Neurol, Lhasa, Peoples R China; [Liu, Chang] Chongqing Med Univ, Neurol, Affiliated Hosp 2, Chongqing, Peoples R China; [Zhang, Xiao] Northwest Univ, Xian Hosp 3, Neurol, Affiliated Hosp, Xian, Peoples R China; [Qiu, Zhongming] 903rd Hosp Peoples Liberat Army, Neurol, Hangzhou, Peoples R China; [Qiu, Zhongming] 903rd Hosp Peoples Liberat Army, Hangzhou, Peoples R China"

通信作者："Wang, SJ (通讯作者)，Yanan Univ, Xianyang Hosp, 38 Middle Sect Wenlin Rd, Xianyang, Peoples R China.; Qiu, ZM (通讯作者)，903rd Hosp Peoples Liberat Army, Hangzhou, Peoples R China.; Yang, QW (通讯作者)，Third Mil Med Univ, Army Med Univ, Xinqiao Hosp, Chongqing, Peoples R China.; Yang, QW (通讯作者)，Third Mil Med Univ, Army Med Univ, Affiliated Hosp 2, Chongqing, Peoples R China."

来源：STROKE

ESI学科分类：NEUROSCIENCE & BEHAVIOR

WOS号：WOS:000991965700028

JCR分区：Q1

影响因子：7.8

年份：2023

卷号：54

期号：6

开始页：1569

结束页：1577

文献类型：Article

关键词：ischemic stroke; patient selection; perfusion; thrombectomy; tomography

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."

基金机构："National Natural Science Foundation of China [81901236, 82071323]"

基金资助正文："The study was supported by the National Natural Science Foundation of China (Nos. 81901236, and 82071323). The funders/sponsors had no role in the design or conduct of the study."