Article ; Online: Brain imaging prior to thrombectomy in the late window of large vessel occlusion ischemic stroke: a systematic review and meta-analysis.
2024 Volume 66, Issue 5, Page(s) 809–816
Abstract: Purpose: Optimal imaging modalities to select patients for endovascular thrombectomy (EVT) in the late window of acute ischemic stroke due to large vessel occlusions (AIS-LVO) are not known. We conducted a systematic review comparing outcomes of ... ...
Abstract | Purpose: Optimal imaging modalities to select patients for endovascular thrombectomy (EVT) in the late window of acute ischemic stroke due to large vessel occlusions (AIS-LVO) are not known. We conducted a systematic review comparing outcomes of patients selected by non-contrast computed tomography (NCCT)/CT angiography (CTA) vs. those selected by CT perfusion (CTP) or magnetic resonance imaging (MRI) for EVT in these patients. Methods: We searched PUBMED, EMBASE, and the Cochrane Library from January 1, 2000, to July 15, 2023, to identify studies comparing outcomes of patients selected for EVT by NCCT/CTA vs. CTP or MRI in the late time window for AIS-LVO. Primary outcome was independence (mRS 0-2) at 90 days or discharge. Secondary outcomes were symptomatic intracranial hemorrhage (sICH) and mortality. We pooled data across studies based on an inverse variance method. Results: Six cohort studies with 4208 patients were included. Pooled results showed no significant difference in the rate of independence at 90 days or discharge (RR 0.96, 95% CI 0.88-1.03) and sICH (RR 1.26, 0.85-1.86) between patients selected by NCCT/CTA vs. CTP or MRI for EVT in the late window of AIS-LVO. However, patients selected by NCCT/CTA vs. CTP or MRI for EVT were associated with a higher risk of mortality (RR 1.21, 1.06-1.39). Conclusion: For AIS-LVO in the late window, patients selected by NCCT/CTA compared with those selected by CTP or MRI for EVT might have a comparable rate of functional independence and sICH. Baseline NCCT/CTA may triage AIS-LVO in the late window. |
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MeSH term(s) | Humans ; Ischemic Stroke ; Stroke/diagnostic imaging ; Stroke/surgery ; Brain Ischemia/diagnostic imaging ; Brain Ischemia/surgery ; Endovascular Procedures/methods ; Thrombectomy/methods ; Intracranial Hemorrhages ; Neuroimaging ; Treatment Outcome |
Language | English |
Publishing date | 2024-03-01 |
Publishing country | Germany |
Document type | Meta-Analysis ; Systematic Review ; Journal Article |
ZDB-ID | 123305-1 |
ISSN | 1432-1920 ; 0028-3940 |
ISSN (online) | 1432-1920 |
ISSN | 0028-3940 |
DOI | 10.1007/s00234-024-03324-z |
Database | MEDical Literature Analysis and Retrieval System OnLINE |
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