Thrombectomy With and Without Computed Tomography Perfusion Imaging in the Early Time Window: A Pooled Analysis of Patient-Level Data

作者：Ashutosh Prabhakar Jadhav, Mayank Goyal, Johanna Maria Ospel, Bruce C.V. Campbell, Charles B.L.M. Majoie, Diederik W.J. Dippel, Phil White, Serge Bracard, Françis Guillemin, Antoni Dávalos, Michael D. Hill, Andrew M. Demchuk, Scott B. Brown, Jeffrey L. Saver, Keith W. Muir, Peter John Mitchell, Shashvat M. Desai, Tudor G. Jovin · 发表于：Stroke · 年份：2021 · DOI：10.1161/strokeaha.121.034331 · 被引用次数：32 · 研究领域：Acute Ischemic Stroke Management、Venous Thromboembolism Diagnosis and Management、Cerebrovascular and Carotid Artery Diseases

BACKGROUND: The optimal imaging paradigm for endovascular thrombectomy (EVT) patient selection in early time window (0-6 hours) treated acute ischemic stroke patients remains uncertain. We aimed to compare post-EVT outcomes between patients who underwent prerandomization basic (noncontrast computed tomography [CT], CT angiography only) versus additional advanced imaging (computed tomography perfusion [CTP] imaging) and to determine the association of performance of prerandomization CTP imaging with clinical outcomes. METHODS: The HERMES collaboration (Highly Effective Reperfusion Evaluated in Multiple Endovascular Stroke Trials) pooled patient-level data from randomized controlled trials comparing EVT with usual care for acute ischemic stroke due to anterior circulation large vessel occlusion. Good functional outcome, defined as modified Rankin Scale score 0 to 2 at 90 days, was compared between randomized patients with and without CTP baseline imaging. Univariable and multivariable binary logistic regression analysis was performed to determine the association of baseline CTP imaging and good functional outcome. RESULTS: We analyzed 1348 patients 610 (45.3%) of whom underwent CTP prerandomization. The benefit of EVT compared with best medical management was maintained irrespective of the baseline imaging paradigm (90-day modified Rankin Scale score 0-2 in EVT versus control patients: with CTP: 46.0% (137/298) versus 28.9% (88/305), without CTP: 44.1% (162/367) versus 27.3% (1...