Rodrigo-Gisbert M.a· Requena M.a,b· De Dios Lascuevas M.a· García-Tornel Á.a· Olivé-Gadea M.a· Boned S.a· Muchada M.a· Deck M.a· Rodríguez-Villatoro N.a· Rodríguez-Luna D.a· Juega J.a· Pagola J.a· Tomasello A.b· Piñana C.b· Hernández D.b· Coscojuela P.b· Ribó M.a· Molina C.A.a· Rubiera M.a

Author affiliations

aStroke Unit, Department of Neurology, Hospital Universitari Vall d’Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
bDepartment of Neuroradiology, Hospital Universitari Vall d’Hebron, Departament de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain

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Article / Publication Details

First-Page Preview

Received: February 18, 2022
Accepted: July 20, 2022
Published online: November 01, 2022

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

Abstract

Introduction: Endovascular treatment (EVT) for acute ischemic stroke (AIS) between 6 and 24 h is established as a standard of care among patients selected by multiparametric neuroimaging. We aimed to explore neuroimaging parameters in late-window large vessel occlusion (LVO) patients and its association with non-contrast computed tomography (NCCT) findings. Methods: We included consecutive AIS patients within 6–24 h from the symptoms onset with LVO. We described multiparametric imaging findings, the rate of patients who fulfilled imaging perfusion criteria according to the DAWN and DEFUSE-3 trials that define the computed tomography perfusion mismatch (CTP-MM) group and its association with NCCT focused on Alberta Stroke Program Early CT Score (ASPECTS). We also analyzed the association between neuroimaging parameters and the clinical outcome determined by the 90-day modified Rankin scale (mRS). Results: We included 206 patients, of them, 176 (85.4%) presented CTP-MM and 184 (89.3%) presented an ASPECTS ≥6 on admission. The rate of CTP-MM was 90.8% in patients with ASPECTS ≥6, compared with 40.9% in those with low ASPECTS. ASPECTS was moderately correlated with ischemic core determined by cerebral blood flow <30% volume (rS = −0.557, p < 0.001). In EVT-treated patients (185, 89.8%), after adjusting for identifiable confounders, the presence of CTP-MM was a predictor of 90-day functional independence (OR: 3.38; 95% CI: 1.01–11.29; p = 0.048). We did not find an association between CTP-MM and 90-day functional disability (ordinal mRS shift, aOR: 1.39; 95% CI: 0.58–3.34; p = 0.459). Conclusions: A great majority of patients who presented a LVO in the late window fulfilled guidelines imaging criteria to undergo EVT, especially those with high ASPECTS (≥6). Our data suggest that NCCT with CT angiography could be a reasonable approach for AIS treatment selection also in the late window.

© 2022 S. Karger AG, Basel

References Powers WJ, Rabinstein AA, Ackerson T, Adeoye OM, Bambakidis NC, Becker K, et al. Guidelines for the early management of patients with acute ischemic stroke: 2019 update to the 2018 guidelines for the early management of acute ischemic stroke: a guideline for healthcare professionals from the American heart association/American stroke association. Stroke. 2019;50(12):e344–e418. Turc G, Bhogal P, Fischer U, Khatri P, Lobotesis K, Mazighi M, et al. European Stroke Organisation (ESO) - European Society for Minimally Invasive Neurological Therapy (ESMINT) guidelines on mechanical thrombectomy in acute ischemic stroke. J Neurointerv Surg. 2019;11(6):535–8. Albers GW, Lansberg MG, Brown S, Jadhav AP, Haussen DC, Martins SO, et al. Assessment of optimal patient selection for endovascular thrombectomy beyond 6 hours after symptom onset: a pooled analysis of the AURORA database. JAMA Neurol. 2021;78(9):1064–71. Nogueira RG, Jadhav AP, Haussen DC, Bonafe A, Budzik RF, Bhuva P, et al. Thrombectomy 6 to 24 hours after stroke with a mismatch between deficit and infarct. N Engl J Med. 2018;378(1):11–21. Albers GW, Marks MP, Kemp S, Christensen S, Tsai JP, Ortega-Gutierrez S, et al. Thrombectomy for stroke at 6 to 16 hours with selection by perfusion imaging. N Engl J Med. 2018;378(8):708–18. Goyal M, Jadhav AP, Bonafe A, Diener H, Mendes Pereira V, Levy E, et al. Analysis of workflow and time to treatment and the effects on outcome in endovascular treatment of acute ischemic stroke: results from the SWIFT PRIME randomized controlled trial. Radiology. 2016;279(3):888–97. Meinel TR, Kaesmacher J, Mosimann PJ, Seiffge D, Jung S, Mordasini P, et al. Association of initial imaging modality and futile recanalization after thrombectomy. Neurology. 2020;95(17):e2331–e2342. Nogueira RG, Haussen DC, Liebeskind D, Jovin TG, Gupta R, Jadhav A, et al. Stroke imaging selection modality and endovascular therapy outcomes in the early and extended time windows. Stroke. 2021;52(2):491–7. Nguyen TN, Abdalkader M, Nagel S, Qureshi MM, Ribo M, Caparros F, et al. Noncontrast computed tomography vs computed tomography perfusion or magnetic resonance imaging selection in late presentation of stroke with large-vessel occlusion. JAMA Neurol. 2022;79(1):22–31. Nogueira RG, Ribo M. Endovascular treatment of acute stroke. Stroke. 2019;50(9):2612–8. Desai SM, Tonetti DA, Molyneaux BJ, Atchaneeyasakul K, Rocha M, Jovin TG, et al. Interaction between time, ASPECTS, and clinical mismatch. J NeuroIntervent Surg. 2020;12(9):911–4. Voleti S, Vidovich J, Corcoran B, Zhang B, Khandwala V, Mistry EA, et al. Correlation of alberta stroke program early computed tomography score with computed tomography perfusion core in large vessel occlusion in delayed time windows. Stroke. 2021 Jan;52(2):498–504. Saver JL, Goyal M, van der Lugt A, Menon BK, Majoie CBLM, Dippel DW, et al. Time to treatment with endovascular thrombectomy and outcomes from ischemic stroke: a meta-analysis. JAMA. 2016;316(12):1279–88. Ribo M, Molina CA, Cobo E, Cerda N, Tomasello A, Quesada H, et al. Association between time to reperfusion and outcome is primarily driven by the time from imaging to reperfusion. Stroke. 2016;47(4):999–1004. Amukotuwa SA, Wu A, Zhou K, Page I, Brotchie P, Bammer R. Distal medium vessel occlusions can be accurately and rapidly detected using tmax maps. Stroke. 2021 Oct;52(10):3308–17. Olive-Gadea M, Requena M, Diaz F, Boned S, Garcia-Tornel A, Muchada M, et al. Systematic CT perfusion acquisition in acute stroke increases vascular occlusion detection and thrombectomy rates. J Neurointerv Surg. 2021 Dec 2;018241. Psychogios MN, Behme D, Schregel K, Tsogkas I, Maier IL, Leyhe JR, et al. One-stop management of acute stroke patients: minimizing door-to-reperfusion times. Stroke. 2017;48(11):3152–5. Requena M, Olivé-Gadea M, Muchada M, Hernández D, Rubiera M, Boned S, et al. Direct to angiography suite without stopping for computed tomography imaging for patients with acute stroke: a randomized clinical trial. JAMA Neurol. 2021 Sep 1;78(9):1099–107. Mendez B, Requena M, Aires A, Martins N, Boned S, Rubiera M, et al. Direct transfer to angio-suite to reduce workflow times and increase favorable clinical outcome. Stroke. 2018;49(11):2723–7. Jadhav AP, Kenmuir CL, Aghaebrahim A, Limaye K, Wechsler LR, Hammer MD, et al. Interfacility transfer directly to the neuroangiography suite in acute ischemic stroke patients undergoing thrombectomy. Stroke. 2017;48(7):1884–9. Pfaff JAR, Schönenberger S, Herweh C, Ulfert C, Nagel S, Ringleb PA, et al. Direct transfer to angio-suite versus computed tomography-transit in patients receiving mechanical thrombectomy: a randomized trial. Stroke. 2020;51(9):2630–8. Maier IL, Leyhe JR, Tsogkas I, Behme D, Schregel K, Knauth M, et al. Diagnosing early ischemic changes with the latest-generation flat detector CT: a comparative study with multidetector CT. AJNR Am J Neuroradiol. 2018;39(5):881–6. Campbell BCV, Majoie CBLM, Albers GW, Menon BK, Yassi N, Sharma G, et al. Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data. Lancet Neurol. 2019 Jan;18(1):46–55. Article / Publication Details

First-Page Preview

Received: February 18, 2022
Accepted: July 20, 2022
Published online: November 01, 2022

Number of Print Pages: 9
Number of Figures: 3
Number of Tables: 3

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: https://www.karger.com/CED

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