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Effect of Imaging Selection Paradigms on Endovascular Thrombectomy Outcomes in Patients With Acute Ischemic Stroke.
Miao, Jian; Sang, Hongfei; Li, Fengli; Saver, Jeffrey L; Lei, Bo; Li, Jinglun; Nogueira, Raul Gomes; Song, Bo; Liu, Shudong; Nguyen, Thanh N; Jin, Zhenglong; Zeng, Hongliang; Wen, Changming; Yuan, Guangxiong; Kong, Weilin; Luo, Weidong; Liu, Shuai; Xie, Dongjing; Huang, Jiacheng; Liu, Chang; Yang, Jie; Hu, Jinrong; Song, Jiaxing; Yue, Chengsong; Li, Linyu; Tian, Yan; Zhang, Xiao; Feng, Dan; Gao, Yani; Fu, Huiying; Zi, Wenjie; Yang, Qingwu; Qiu, Zhongming; Wang, Shaojun.
Afiliación
  • Miao J; Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).
  • Sang H; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Li F; Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, China (H.S.).
  • Saver JL; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Lei B; Neurology, David Geffen School of Medicine at UCLA (J.L.S.).
  • Li J; Cerebrovascular Diseases, Leshan People's Hospital, China (B.L.).
  • Nogueira RG; Neurology, Affiliated Hospital of Southwest Medical University, Luzhou, China (J.L.).
  • Song B; UPMC Stroke Institute, University of Pittsburgh School of Medicine (R.G.N.).
  • Liu S; Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).
  • Nguyen TN; Neurology, Yongchuan Hospital of Chongqing Medical University, Chongqing Key Laboratory of Cerebrovascular Disease Research, China (S.L.).
  • Jin Z; Neurology, Boston Medical Center (T.N.N.).
  • Zeng H; Neurology, Wuyi Hospital of Traditional Chinese Medicine, Jiangmen, China (Z.J.).
  • Wen C; Neurology, Ganzhou People's Hospital, China (H.Z.).
  • Yuan G; Neurology, Nanyang Central Hospital, China (C.W.).
  • Kong W; Emergency, Xiangtan Central Hospital, China (G.Y.).
  • Luo W; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Liu S; Neurology, The General Hospital of Tibet Military Area Command, Lhasa, China (W.L.).
  • Xie D; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Huang J; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Liu C; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Yang J; Neurology, The Second Affiliated Hospital of Chongqing Medical University, China (C.L.).
  • Hu J; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Song J; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Yue C; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Li L; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Tian Y; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Zhang X; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Feng D; Neurology, The Affiliated Hospital of Northwest University Xi'an No.3 Hospital, China (X.Z.).
  • Gao Y; Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).
  • Fu H; Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).
  • Zi W; Neurology, Xianyang Hospital of Yan'an University, China (J.M., B.S., D.F., Y.G., H.F., S.W.).
  • Yang Q; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Qiu Z; Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), Chongqing, China (J.M., F.L., W.K., S.L., D.X., J.H., J.Y., J.H., J.S., C.Y., L.L., Y.T., W.Z., Q.Y.).
  • Wang S; Neurology, The 903rd Hospital of The People's Liberation Army, Hangzhou, China (Z.Q.).
Stroke ; 54(6): 1569-1577, 2023 06.
Article en En | MEDLINE | ID: mdl-37165864
ABSTRACT

BACKGROUND:

The effect of imaging selection paradigms on endovascular thrombectomy outcomes in patients with acute ischemic stroke with large vessel occlusion remains uncertain. The study aimed to assess the effect of basic imaging (noncontrast computed tomography with or without computed tomographic angiography) versus advanced imaging (magnetic resonance imaging or computed tomography perfusion) on clinical outcomes following thrombectomy in patients with stroke with large vessel occlusion in the early and extended windows using a pooled analysis of patient-level data from 2 pivotal randomized clinical trials done in China.

METHODS:

This post hoc analysis used data from 1182 patients included in 2 multicenter, randomized controlled trials in China that evaluated adjunct therapies to endovascular treatment for acute ischemic stroke (Direct Endovascular Treatment for Large Artery Anterior Circulation Stroke performed from May 20, 2018, through May 2, 2020, and Intravenous Tirofiban Before Endovascular Treatment in Stroke from October 10, 2018, through October 31, 2021). Patients with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery (M1/M2 segments) were categorized according to baseline imaging modality (basic versus advanced) as well as treatment time window (early, 0-6 hours versus extended, 6-24 hours from last known well to puncture). The primary outcome was the proportion of patients with functional independence (modified Rankin Scale score of 0-2) at 90 days. Multivariable Poisson regression analysis was performed to determine the association between imaging selection modality and outcomes after endovascular treatment at each time windows.

RESULTS:

A total of 1182 patients were included in this cohort analysis, with 648 in the early (471 with basic imaging versus 177 advanced imaging) and 534 in the extended (222 basic imaging versus 312 advanced imaging) time window. There were no differences in 90-day functional independence between the advanced and basic imaging groups in either time windows (early window adjusted relative risk, 0.99 [95% CI, 0.84-1.16]; P=0.91; extended window adjusted relative risk, 1.00 [95% CI, 0.84-1.20]; P=0.97).

CONCLUSIONS:

In this post hoc analysis of 2 randomized clinical trial pooled data involving patients with large vessel occlusion stroke, an association between imaging selection modality and clinical or safety outcomes for patients undergoing thrombectomy in either the early or extended windows was not detected. Our study adds to the growing body of literature on simpler imaging paradigms to assess thrombectomy eligibility across both the early and extended time windows. REGISTRATION URL http//www.chictr.org.cn; Unique identifiers ChiCTR-IOR-17013568 and ChiCTR-INR-17014167.
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Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares / Accidente Cerebrovascular Isquémico Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Stroke Año: 2023 Tipo del documento: Article
Texto completo
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Buscar en Google

Texto completo: 1 Colección: 01-internacional Banco de datos: MEDLINE Asunto principal: Isquemia Encefálica / Accidente Cerebrovascular / Procedimientos Endovasculares / Accidente Cerebrovascular Isquémico Tipo de estudio: Clinical_trials / Etiology_studies / Observational_studies / Prognostic_studies Límite: Humans Idioma: En Revista: Stroke Año: 2023 Tipo del documento: Article