Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion
JAMA Neurology (11/08/21) DOI: 10.1001/jamaneurol.2021.4082
Nguyen, Thanh N.; Abdalkader, Mohamad; Nagel, Simon; et al.
The results of a new study show no significant differences in the clinical outcomes for patients undergoing proximal anterior circulation mechanical thrombectomy in the extended time window who were selected with noncontrast computed tomography (CT) compared with those selected by computed tomography perfusion (CTP) or magnetic resonance imaging (MRI). The multinational cohort study included patients with proximal anterior circulation occlusion stroke presenting within 6 - 24 hours of time last seen well from January 2014 to December 2020. Patients were followed for 90 days from stroke onset, and the primary endpoint was the distribution of modified Rankin Scale (mRS) scores at that point (ordinal shift). Of the 1,604 patients included (median age 70 years, 52.9% women), 534 were selected to undergo mechanical thrombectomy by CT, 752 by CTP, and 318 by MRI. The researchers found, after adjusting for confounders, no difference in 90-day ordinal mRS shift between patients selected by CT compared with CTP or CT compared with MRI. The 90-day functional independence rates were lower in patients selected by MRI vs. CT; however, the rates were similar between patients selected by CT vs. CTP. The rates of successful reperfusion in the CT, CTP, and MRI groups were 88.9%, 89.5%, and 78.9%, respectively. There were no significant differences in symptomatic intracranial hemorrhage or 90-day mortality. "These findings have the potential to widen the indication for treating patients in the extended window using the simpler, less costly, and easier to implement [noncontrast CT] imaging as an alternative to CTP or MRI," the researchers conclude.