CT Perfusion vs Noncontrast CT for Late Window Stroke Thrombectomy

Abstract

Background:Patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) in the late window (6-24 hours) can be evaluated with computed tomography perfusion (CTP) or with noncontrast computed tomography (NCCT) only. Whether outcomes differ depending on type of imaging selection is unknown. We conducted a systematic review and meta-analysis comparing outcomes between CTP and NCCT for EVT selection in the late therapeutic window.Methods:This study is reported according to the PRISMA 2020 guidelines. A systematic literature review of the English language literature was conducted using Web of Science, Embase, Scopus, and PubMed databases. Papers focusing on late window AIS undergoing EVT imaged via CTP and NCCT were included. Data were pooled using a random-effects model. The primary outcome of interest was rate of functional independence, defined as modified Rankin Scale (mRS) 0-2. Secondary outcomes of interest included rates of successful reperfusion, defined as thrombolysis in cerebral infarction (TICI) 2b-3, mortality, and symptomatic intracranial hemorrhage (sICH).Results:Five studies with 3,384 patients were included in our analysis. There were comparable rates of functional independence (OR= 1.03, 95% CI, 0.87-1.22; P-value= 0.71) and sICH (OR= 1.09, 95% CI, 0.58-2.04; P-value= 0.80) between the two groups. Patients imaged with CTP had higher rates of successful reperfusion (OR= 1.31, 95% CI, 1.05-1.64; P-value= 0.015) and lower rates of mortality (OR= 0.79, 95% CI, 0.65-0.96; P-value= 0.017).Conclusions:Although recovery of functional independence after late window EVT was not more common in patients selected by CTP as compared to patients selected by NCCT only, patients selected by CTP had lower mortality.

Sequential mechanical thrombectomies in acute bilateral middle cerebral artery strokes: A case report and review of literature

“…In a meta-analysis, patients selected for mechanical thrombectomy using CTP demonstrated higher rates of successful reperfusion and lower rates of mortality compared to patients assessed with non-contrast CT alone in the late window period. [ 7 ] Endovascular therapy has shown promising results in patients with LVO stroke in the past few years. However, the optimal endovascular treatment of simultaneous occlusion of bilateral MCA has not yet been optimized.…”

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

“…There have been three published meta-analyses with a similar objective to ours [ 28 – 30 ]. However, all three studies did not exclude a considerable number (>300) duplicated patients from three cohorts included in the meta-analyses [ 7 , 22 , 23 ].…”

Epidemiology, organization, diagnosis and treatment of acute ischemic stroke

“…In a recent metanalysis patients with AIS treated with EVT in the late window (6–24 h) were evaluated with CTP or with NCCT only, there was no difference in recovery of functional independence in patients selected by CTP compared with patients selected by NCCT only [41] .…”