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

Humans Ischemic Stroke Brain Ischemia / diagnostic imaging Endovascular Procedures / methods Stroke / diagnostic imaging Thrombectomy / methods Treatment Outcome Randomized Controlled Trials as Topic
ischemic stroke patient selection perfusion thrombectomy tomography

Journal

Stroke
ISSN: 1524-4628
Titre abrégé: Stroke
Pays: United States
ID NLM: 0235266

Informations de publication

Date de publication:
06 2023
Historique:
medline: 24 5 2023
pubmed: 11 5 2023
entrez: 11 5 2023
Statut: ppublish

Résumé

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. 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. 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]; 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. URL: http://www.chictr.org.cn; Unique identifiers: ChiCTR-IOR-17013568 and ChiCTR-INR-17014167.

Sections du résumé

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];
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.
REGISTRATION
URL: http://www.chictr.org.cn; Unique identifiers: ChiCTR-IOR-17013568 and ChiCTR-INR-17014167.

Identifiants

DOI: 10.1161/STROKEAHA.122.042203 PMID: 37165864
pubmed: 37165864
doi: 10.1161/STROKEAHA.122.042203
doi:

Banques de données

ChiCTR
['ChiCTR-IOR-17013568', 'ChiCTR-INR-17014167']

Types de publication

Multicenter Study Journal Article Research Support, Non-U.S. Gov't

Langues

eng

Sous-ensembles de citation

IM

Pagination

1569-1577

Auteurs

Jian Miao (J)

Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).
Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
ORCID: 0000-0001-5055-9388

Hongfei Sang (H)

Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, China (H.S.).
ORCID: 0000-0001-6156-0392

Fengli Li (F)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
ORCID: 0000-0002-5899-9270

Jeffrey L Saver (JL)

Neurology, David Geffen School of Medicine at UCLA (J.L.S.).
ORCID: 0000-0001-9141-2251

Bo Lei (B)

Cerebrovascular Diseases, Leshan People's Hospital, China (B.L.).

Jinglun Li (J)

Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China (J.L.).

Raul Gomes Nogueira (RG)

UPMC Stroke Institute, University of Pittsburgh School of Medicine (R.G.N.).
ORCID: 0000-0003-4532-153X

Bo Song (B)

Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).

Shudong Liu (S)

Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, China (S.L.).

Thanh N Nguyen (TN)

Neurology, Boston Medical Center (T.N.N.).
ORCID: 0000-0002-2810-1685

Zhenglong Jin (Z)

Neurology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China (Z.J.).
ORCID: 0000-0003-1968-0301

Hongliang Zeng (H)

Neurology, Ganzhou People's Hospital, China (H.Z.).

Changming Wen (C)

Neurology, Nanyang Central Hospital, China (C.W.).

Guangxiong Yuan (G)

Emergency, Xiangtan Central Hospital, China (G.Y.).

Weilin Kong (W)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
ORCID: 0000-0001-5478-5083

Weidong Luo (W)

Neurology, The General Hospital of Tibet Military Area Command, Lhasa, China (W.L.).
ORCID: 0000-0001-5282-3090

Shuai Liu (S)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).

Dongjing Xie (D)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).

Jiacheng Huang (J)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
ORCID: 0000-0002-6962-7253

Chang Liu (C)

Neurology, The Second Affiliated Hospital of Chongqing Medical University, China (C.L.).

Jie Yang (J)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).

Jinrong Hu (J)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).

Jiaxing Song (J)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
ORCID: 0000-0002-1945-2360

Chengsong Yue (C)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
ORCID: 0000-0002-0703-0224

Linyu Li (L)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
ORCID: 0000-0002-8419-0133

Yan Tian (Y)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).

Xiao Zhang (X)

Neurology, The Affiliated Hospital of Northwest University Xi'an No.3 Hospital, China (X.Z.).

Dan Feng (D)

Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).

Yani Gao (Y)

Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).

Huiying Fu (H)

Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).

Wenjie Zi (W)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
ORCID: 0000-0001-6323-2659

Qingwu Yang (Q)

Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
ORCID: 0000-0002-2596-2631

Zhongming Qiu (Z)

Neurology, The 903rd Hospital of The People's Liberation Army, Hangzhou, China (Z.Q.).
ORCID: 0000-0002-1622-9526

Shaojun Wang (S)

Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).
ORCID: 0000-0002-4780-9785

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