Article Dans Une Revue JAMA neurology Année : 2021

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

Thanh N. Nguyen
  • Fonction : Auteur
Mohamad Abdalkader
  • Fonction : Auteur
Simon Nagel
  • Fonction : Auteur
Muhammad M. Qureshi
  • Fonction : Auteur
Marc Ribo
  • Fonction : Auteur
Diogo C. Haussen
  • Fonction : Auteur
Mahmoud H. Mohammad
  • Fonction : Auteur
Sunil A. Sheth
  • Fonction : Auteur
Santiago Ortega-Gutierrez
  • Fonction : Auteur
James E. Siegler
  • Fonction : Auteur
Syed Zaidi
  • Fonction : Auteur
Marta Olive-Gadea
  • Fonction : Auteur
Markus A. Möhlenbruch
  • Fonction : Auteur
Alicia C. Castonguay
  • Fonction : Auteur
Stefania Nannoni
  • Fonction : Auteur
Johannes Kaesmacher
  • Fonction : Auteur
Ajit S. Puri
  • Fonction : Auteur
Fatih Seker
  • Fonction : Auteur
Mudassir Farooqui
  • Fonction : Auteur
Sergio Salazar-Marioni
  • Fonction : Auteur
Anna L. Kuhn
  • Fonction : Auteur
Artem Kaliaev
  • Fonction : Auteur
Behzad Farzin
  • Fonction : Auteur
William Boisseau
  • Fonction : Auteur
Hesham E. Masoud
  • Fonction : Auteur
Carlos Ynigo Lopez
  • Fonction : Auteur
Ameena Rana
  • Fonction : Auteur
Samer Abdul Kareem
  • Fonction : Auteur
Anvitha Sathya
  • Fonction : Auteur
Piers Klein
  • Fonction : Auteur
Mohammad W. Kassem
  • Fonction : Auteur
Peter A. Ringleb
  • Fonction : Auteur
Jan Gralla
  • Fonction : Auteur
Urs Fischer
  • Fonction : Auteur
Patrik Michel
  • Fonction : Auteur
Tudor G. Jovin
  • Fonction : Auteur
Jean Raymond
  • Fonction : Auteur
Osama O. Zaidat
  • Fonction : Auteur
Raul G. Nogueira
  • Fonction : Auteur

Résumé

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 (adjusted odds ratio [aOR], 0.95 [95% CI, 0.77-1.17]; P = .64) or CT vs MRI (aOR, 0.95 [95% CI, 0.8-1.13]; P = .55). The rates of 90-day functional independence (mRS scores 0-2 vs 3-6) were similar between patients selected by CT vs CTP (aOR, 0.90 [95% CI, 0.7-1.16]; P = .42) but lower in patients selected by MRI than CT (aOR, 0.79 [95% CI, 0.64-0.98]; P = .03). Successful reperfusion was more common in the CT and CTP groups compared with the MRI group (474 [88.9%] and 670 [89.5%] vs 250 [78.9%]; P < .001). No significant differences in symptomatic intracranial hemorrhage (CT, 42 [8.1%]; CTP, 43 [5.8%]; MRI, 15 [4.7%]; P = .11) or 90-day mortality (CT, 125 [23.4%]; CTP, 159 [21.1%]; MRI, 62 [19.5%]; P = .38) were observed. Conclusions and Relevance In patients undergoing proximal anterior circulation mechanical thrombectomy in the extended time window, there were no significant differences in the clinical outcomes of patients selected with noncontrast CT compared with those selected with CTP or MRI. These findings have the potential to widen the indication for treating patients in the extended window using a simpler and more widespread noncontrast CT–only paradigm.
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Dates et versions

hal-04809898 , version 1 (28-11-2024)

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Citer

Thanh N. Nguyen, Mohamad Abdalkader, Simon Nagel, Muhammad M. Qureshi, Marc Ribo, et al.. Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion.. JAMA neurology, 2021, JAMA neurology, 79 (1), pp.22-31. ⟨10.1001/jamaneurol.2021.4082⟩. ⟨hal-04809898v1⟩

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