Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion

作者：Thanh N. Nguyen, Mohamad Abdalkader, Simon Nagel, Muhammad M. Qureshi, Marc Ribó, François Caparros, Diogo C Haussen, Mahmoud Mohammaden, Sunil A. Sheth, Santiago Ortega‐Gutiérrez, James E. Siegler, Syed Zaidi, Marta Olivé‐Gadea, Hilde Hénon, Markus Möhlenbruch, Alicia C. Castonguay, Stefania Nannoni, Johannes Kaesmacher, Ajit S Puri, Fatih Şeker, Mudassir Farooqui, Sergio Salazar‐Marioni, Anna Luisa Kühn, Artem Kaliaev, Behzad Farzin, William Boisseau, Hesham Masoud, Carlos Ynigo Lopez, Ameena Rana, Samer Abdul Kareem, Anvitha Sathya, Piers Klein, Mohammad W. Kassem, Peter A. Ringleb, Charlotte Cordonnier, Jan Gralla, Urs Fischer, Patrik Michel, Tudor G. Jovin, Jean Raymond, Osama O. Zaidat, Raul G. Nogueira · 发表于：JAMA Neurology · 年份：2021 · DOI：10.1001/jamaneurol.2021.4082 · 被引用次数：278 · 研究领域：Acute Ischemic Stroke Management、Stroke Rehabilitation and Recovery、Cerebrovascular and Carotid Artery Diseases

Importance: Advanced imaging for patient selection in mechanical thrombectomy is not widely available. Objective: To compare the clinical outcomes of patients selected for mechanical thrombectomy by noncontrast computed tomography (CT) vs those selected by computed tomography perfusion (CTP) or magnetic resonance imaging (MRI) in the extended time window. Design, Setting, and Participants: This multinational cohort study included consecutive patients with proximal anterior circulation occlusion stroke presenting within 6 to 24 hours of time last seen well from January 2014 to December 2020. This study was conducted at 15 sites across 5 countries in Europe and North America. The duration of follow-up was 90 days from stroke onset. Exposures: Computed tomography with Alberta Stroke Program Early CT Score, CTP, or MRI. Main Outcomes and Measures: The primary end point was the distribution of modified Rankin Scale (mRS) scores at 90 days (ordinal shift). Secondary outcomes included the rates of 90-day functional independence (mRS scores of 0-2), symptomatic intracranial hemorrhage, and 90-day mortality. Results: Of 2304 patients screened for eligibility, 1604 patients were included, with a median (IQR) age of 70 (59-80) years; 848 (52.9%) were women. A total of 534 patients were selected to undergo mechanical thrombectomy by CT, 752 by CTP, and 318 by MRI. After adjustment of confounders, there was no difference in 90-day ordinal mRS shift between patients selected by CT vs CTP (...