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Brain imaging prior to thrombectomy in the late window of large vessel occlusion ischemic stroke: a systematic review and meta-analysis

  • Interventional Neuroradiology
  • Published:
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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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Funding

This work was supported by Ministry of Science and Technology, Taiwan, grant numbers: MOST 108–2314-B-182–017-, MOST 109–2314-B-182–033-, and MOST 110–2314-B-182–036-MY2, and Chang Gung Memorial Hospital, Taiwan, grant numbers: CMRPG6H0191 and CMRPG6H0441.

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Authors and Affiliations

  1. Division of Neurology, Department of Internal Medicine, Ditmanson Medical Foundation, Chia-Yi Christian Hospital, Chiayi, Taiwan

    Chun-Hsien Lin

  2. Department of Neurology, University of California, San Francisco, San Francisco, CA, USA

    Bruce Ovbiagele

  3. Comprehensive Stroke Center and Department of Neurology, University of California, Los Angeles, Los Angeles, CA, USA

    David S. Liebeskind & Jeffrey L. Saver

  4. Department of Neurology, Chang Gung University College of Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi, Taiwan

    Meng Lee

Authors
  1. Chun-Hsien Lin
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  2. Bruce Ovbiagele
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  4. Jeffrey L. Saver
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Corresponding author

Correspondence to Meng Lee.

Ethics declarations

Competing interests

Dr. Saver reported being an employee of the University of California, which has patent rights in retrieval devices for stroke. The University of California received payments on the basis of clinical trial contracts for the number of participants enrolled in multicenter clinical trials sponsored by Medtronic, Stryker, Cerenovus, BrainsGate, NONO Inc., and Boehringer Ingelheim (prevention only). The University of California receives grant support from the National Institutes of Health (NIH) for Dr. Saver’s service in leadership roles in the National Institute of Neurological Disorders and Stroke StrokeNet national clinical trial network and from Diffusion Pharma for Dr. Saver’s leadership role in the PHAST-TSC multicenter trial. Dr. Saver reported serving as an unpaid consultant to Genentech advising on the design and conduct of the PRISMS trial; neither the University of California nor Dr. Saver received any payments for this voluntary service. Dr. Saver paid for his own travel. Dr. Saver reported receiving contracted hourly payments and travel reimbursement for services as a scientific consultant advising on rigorous trial design and conduct to Medtronic, Stryker, Cerenovus, BrainsGate, Boehringer Ingelheim (prevention only), NONO Inc., BrainQ, and Abbott; contracted stock options for services as a scientific consultant advising on rigorous trial design and conduct to Rapid Medical; and personal fees from Johnson & Johnson and Novo Nordisk. Other authors have no disclosure or conflict of interest.

Ethics approval

This study was a meta-analysis of published papers and did not need IRB or ethic committee approval.

Informed consent

This study was a meta-analysis of published papers and did not enroll patients and therefore did not need informed consent.

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Lin, CH., Ovbiagele, B., Liebeskind, D.S. et al. Brain imaging prior to thrombectomy in the late window of large vessel occlusion ischemic stroke: a systematic review and meta-analysis. Neuroradiology 66, 809–816 (2024). https://doi.org/10.1007/s00234-024-03324-z

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