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Perfusion imaging for endovascular thrombectomy in acute ischemic stroke is associated with improved functional outcomes in the early and late time windows
Dhillon, Permesh Singh Podlasek, Anna McConachie, Norman Lenthall, Robert Nair, Sujit Malik, Luqman Krishnan, Kailash Sprigg, Nikola Bath, Philip M.
Dhillon, Permesh Singh
Podlasek, Anna
McConachie, Norman
Lenthall, Robert
Nair, Sujit
Malik, Luqman
Krishnan, Kailash
Sprigg, Nikola
Bath, Philip M.
Abstract
BACKGROUND: The impact on clinical outcomes of patient selection using perfusion imaging for endovascular thrombectomy (EVT) in patients with acute ischemic stroke presenting beyond 6 hours from onset remains undetermined in routine clinical practice. METHODS: Patients from a national stroke registry that underwent EVT selected with or without perfusion imaging (noncontrast computed tomography/computed tomography angiography) in the early (P=0.001). There was no significant difference in functional independence (29.3% with perfusion versus 24.8% without; P=0.210) or in the safety outcome measures of symptomatic intracerebral hemorrhage (P=0.53) and in-hospital mortality (10.6% with perfusion versus 14.3% without; P=0.053). In the early time window, patients with perfusion imaging had significantly improved odds of functional outcome (adjusted common OR, 1.51 [95% CI, 1.28-1.78]; P=0.0001) and functional independence (41.6% versus 33.6%, adjusted OR, 1.31 [95% CI, 1.08-1.59]; P=0.006). Perfusion imaging was associated with lower odds of futile recanalization in both time windows (late: adjusted OR, 0.70 [95% CI, 0.50-0.97]; P=0.034; early: adjusted OR, 0.80 [95% CI, 0.65-0.99]; P=0.047). CONCLUSIONS: In this real-world study, acquisition of perfusion imaging for EVT was associated with improvement in functional disability in the early and late time windows compared with nonperfusion neuroimaging. These indirect comparisons should be interpreted with caution while awaiting confirmatory data from prospective randomized trials.
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Date
2022
Type
Article
Subject
Ischaemic stroke, Stroke, Thrombectomy, Imaging, Perfusion imaging
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Citation
Dhillon, P.S., Butt, W., Podlasek, A., McConachie, N., Lenthall, R., Nair, S., Malik, L., Booth, T.C., Bhogal, P., Makalanda, H.L.D., Spooner, O., Mortimer, A., Lamin, S., Chavda, S., Chew, H.S., Nader, K., Al-Ali, S., Butler, B., Rajapakse, D., Appleton, J.P., Krishnan, K., Sprigg, N., Smith, A., Lobotesis, K., White, P., James, M.A., Bath, P.M., Dineen, R.A. and England, T.J. (2022) 'Perfusion imaging for endovascular thrombectomy in acute ischemic stroke is associated with improved functional outcomes in the early and late time windows', Stroke, 53(9), pp. 2770-2778. doi: 10.1161/STROKEAHA.121.038010.