Perfusion vs non-perfusion computed tomography imaging in the late window of emergent large vessel ischemic stroke: A systematic review and meta-analysis.

Journal

PloS one
ISSN: 1932-6203
Titre abrégé: PLoS One
Pays: United States
ID NLM: 101285081

Informations de publication

Date de publication:
2024
Historique:
received: 01 09 2023
accepted: 25 10 2023
medline: 3 1 2024
pubmed: 3 1 2024
entrez: 2 1 2024
Statut: epublish

Résumé

Guidelines recommend the treatment of emergent large vessel ischemic stroke (ELVIS) patients presenting beyond 6 hours of last known well time with endovascular thrombectomy (EVT) based on perfusion computed tomography (CT) neuroimaging. We compared the outcomes (long-term good clinical outcomes, symptomatic intracranial hemorrhage (sICH), and mortality) of ELVIS patients according to the type of CT neuroimaging they underwent. We searched the following databases: Medline, Embase, CENTRAL, and Scopus from January 1, 2015, to June 14, 2023. We included studies of late-presenting ELVIS patients undergoing EVT that had with data for non-perfusion and perfusion CT neuroimaging. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data were pooled using a random effects model. We found 7 observational cohorts. Non-perfusion versus perfusion CT was not statistically significantly different for both long-term clinical (n = 3,224; RR: 0.96; 95% CI 0.86 to 1.06; I2 = 18%) and sICH (n = 3,724; RR: 1.08 95% CI 0.60 to 1.94; I2 = 76%). Perfusion CT had less mortality (n = 3874; RR: 1.22; 95% CI 1.07 to 1.40; I2 = 0%). The certainty of these findings is very low because of limitations in the risk of bias, indirectness, and imprecision domains of the Grading of Recommendations, Assessment, Development and Evaluations. The use of either non-perfusion or perfusion CT neuroimaging may have little to no effect on long-term clinical outcomes and sICH for late-presenting EVT patients. Perfusion CT neuroimaging may be associated with a reduced the risk of mortality. Evidence uncertainty warrants randomized trial data.

Sections du résumé

BACKGROUND BACKGROUND
Guidelines recommend the treatment of emergent large vessel ischemic stroke (ELVIS) patients presenting beyond 6 hours of last known well time with endovascular thrombectomy (EVT) based on perfusion computed tomography (CT) neuroimaging. We compared the outcomes (long-term good clinical outcomes, symptomatic intracranial hemorrhage (sICH), and mortality) of ELVIS patients according to the type of CT neuroimaging they underwent.
METHODS METHODS
We searched the following databases: Medline, Embase, CENTRAL, and Scopus from January 1, 2015, to June 14, 2023. We included studies of late-presenting ELVIS patients undergoing EVT that had with data for non-perfusion and perfusion CT neuroimaging. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data were pooled using a random effects model.
RESULTS RESULTS
We found 7 observational cohorts. Non-perfusion versus perfusion CT was not statistically significantly different for both long-term clinical (n = 3,224; RR: 0.96; 95% CI 0.86 to 1.06; I2 = 18%) and sICH (n = 3,724; RR: 1.08 95% CI 0.60 to 1.94; I2 = 76%). Perfusion CT had less mortality (n = 3874; RR: 1.22; 95% CI 1.07 to 1.40; I2 = 0%). The certainty of these findings is very low because of limitations in the risk of bias, indirectness, and imprecision domains of the Grading of Recommendations, Assessment, Development and Evaluations.
CONCLUSION CONCLUSIONS
The use of either non-perfusion or perfusion CT neuroimaging may have little to no effect on long-term clinical outcomes and sICH for late-presenting EVT patients. Perfusion CT neuroimaging may be associated with a reduced the risk of mortality. Evidence uncertainty warrants randomized trial data.

Identifiants

DOI: 10.1371/journal.pone.0294127 PMID: 38166040
pubmed: 38166040
doi: 10.1371/journal.pone.0294127
pii: PONE-D-23-28230
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

e0294127

Informations de copyright

Copyright: © 2024 Diestro et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Déclaration de conflit d'intérêts

The authors have declared that no competing interests exist in relation to this particular work.

Auteurs

Jose Danilo B Diestro (JDB)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
ORCID: 0000-0001-8450-2021

Abdelsimar T Omar (AT)

Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.

Yu-Qing Zhang (YQ)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
CEBIM (Center for Evidence Based Integrative Medicine)-Clarity Collaboration, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
Nottingham Ningbo GRADE Center, The University of Nottingham Ningbo, Ningbo, China.

Teruko Kishibe (T)

Health Sciences Library, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.

Alexander Mastrolonardo (A)

Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada.

Melissa Mary Lannon (MM)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.

Katrina Ignacio (K)

Department of Clinical Neurosciences, Cumming School of Medicine, University of Calgary, Alberta, Canada.
ORCID: 0000-0001-7263-8474

Eduardo Pimenta Ribeiro Pontes Almeida (E)

University Health Network-Toronto General Hospital, Toronto, Ontario, Canada.
ORCID: 0000-0001-8196-866X

Anahita Malvea (A)

Division of Neurosurgery, Department of Surgery, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Ange Diouf (A)

Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Arjun Vishnu Sharma (AV)

Department of Neurology and Critical Care, McMaster University, Hamilton, ON, Canada.

Qingwu Yang (Q)

Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Shapingba District, Chongqing, China.

Zhongming Qiu (Z)

Department of Neurology, The 903rd Hospital of The People's Liberation Army, Xihu District, Hangzhou, China.

Mohammed A Almekhlafi (MA)

Department of Clinical Neurosciences, Radiology, and Community Health Sciences, Cumming School of Medicine at the University of Calgary, Calgary, Alberta, Canada.
Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine at the University of Calgary, Calgary, Alberta, Canada.

Thanh N Nguyen (TN)

Department of Neurology, Boston University School of Medicine, Boston, Massachusetts, United States of America.
Department of Radiology, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts, United States of America.

Atif Zafar (A)

Department of Medicine, Division of Neurology, Unity Health- St. Michael's Hospital, University of Toronto, Toronto, Ontario.

Vitor Mendes Pereira (VM)

Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Neurosurgery, Department of Surgery, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Julian Spears (J)

Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Neurosurgery, Department of Surgery, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Thomas R Marotta (TR)

Division of Diagnostic and Therapeutic Neuroradiology, Department of Medical Imaging, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Neurosurgery, Department of Surgery, Unity Health- St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.

Forough Farrokhyar (F)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Department of Global Health, McMaster University, Hamilton, Ontario, Canada.
Department of Surgery, McMaster University, Hamilton, Ontario, Canada.

Sunjay Sharma (S)

Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Division of Neurosurgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.

Classifications MeSH