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Effect of computed tomography vs. computed tomography perfusion on mechanical thrombectomy outcomes within 6 hours

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Abstract

Objectives

It is unclear which selection strategy, plain CT vs. CT perfusion (CTP), is more powerful in predicting outcome after mechanical thrombectomy (MT). We aimed to compare the effect of plain CT and CTP in predicting outcome after MT within 6 h.

Methods

We conducted a prospective analysis of a retrospective cohort from our single-center study, which had occlusion of the internal carotid artery and middle cerebral artery up to the proximal M2 segment and received MT within 6 h. According to the Alberta Stroke Program Early CT Score (ASPECTS), patients were divided into a high-ASPECTS group (≥ 6) and a low ASPECTS group (< 6). Similarly, patients were divided into mismatch and no-mismatch groups according to the DEFUSE3 criteria for CTP. A good outcome was defined as a 90-day modified Rankin Scale (mRS) score of ≤ 3. Univariate and binary logistic regression analyses were used to investigate the association between different imaging modality and 90-day mRS score, and mortalities, respectively.

Results

The high ASPECTS group included 307 patients (89.2%). The mismatch group included 189 (54.9%) patients meeting the DEFUSE3 criterion. Compared to the low ASPECTS group, the high ASPECTS group had a good outcome (odds ratio (OR), 2.285; [95% confidence interval (CI) (1.106, 4.723)], p = 0.026) and lower mortality (OR, 0.350; [95% CI (0.163, 0.752)], p = 0.007). However, there were no significant differences in good outcomes and mortality between the mismatch and no-mismatch groups.

Conclusions

Compared with plain CT, CTP does not provide additional benefits in the selection of patients suitable for MT within 6 h.

Clinical relevance statement

CT perfusion is not superior to plain CT for the prediction of clinical outcomes when selecting patients for mechanical thrombectomy in the first 6 h. In that clinical setting, plain CT may be safe in the absence of perfusion data.

Key Points

• The advantage of CT perfusion (CTP) over CT in pre-mechanical thrombectomy (MT) screening has not been proven for patients with a large infarct core.

• CTP is not better than plain CT in predicting good outcome following MT within 6 h.

• Plain CT is sufficient for selecting patients suitable for MT within 6 h of large artery occlusion.

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Abbreviations

AIS:

Acute ischemic stroke

AOL:

Arterial occlusive lesion

ASPECTS:

Alberta Stroke Program Early CT Score

CI:

Confidence interval

CTP:

CT perfusion

IQR:

Interquartile range

IVT:

Intravenous thrombolysis

LVO:

Large vessel occlusion

mRS:

Modified Rankin Scale

MT:

Mechanical thrombectomy

NIHSS:

National Institutes of Health Stroke Scale

OR:

Odds ratio

PH:

Parenchymal hematoma

RCTs:

Randomized controlled trials

SD:

Standard deviation

sICH:

Symptomatic intracerebral hemorrhage

TIA:

Transient ischemic attack

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Acknowledgements

Z.C. had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Z.C. designed the whole study and supervised the whole project, monitored data collection, drafted the manuscript, and approved the final version of the manuscript. Concept and design: Y.P. and Z.C. Acquisition, analysis, or interpretation of data: Y.P., YC. Critical revision of the manuscript for important intellectual content: Y.P., YC, WZ, YH, YZ, ML. Statistical analysis: Y.P., YC. Obtained funding: Z.C., ML. All authors contributed to the development of the manuscript and approved the final draft. The corresponding authors attest that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

Funding

This study was supported by the National Natural Science Foundation of China (81971101, 82171276).

Author information

Authors and Affiliations

  1. Department of Neurology, The Second Affiliated Hospital of Zhejiang University, School of Medicine, Hangzhou, 310009, China

    Yingjian Pei, Yuping Chen, Wansi Zhong, Yaode He, Zhongyu Luo, Min Lou & Zhicai Chen

Authors
  1. Yingjian Pei
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  2. Yuping Chen
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  3. Wansi Zhong
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  4. Yaode He
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  5. Zhongyu Luo
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  6. Min Lou
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  7. Zhicai Chen
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Corresponding authors

Correspondence to Min Lou or Zhicai Chen.

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Guarantor

The scientific guarantor of this publication is Zhicai Chen.

Conflict of interest

The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent for MT was obtained from all patients or their legally authorized representatives. Because patient information was de-identified and anonymized before being released to the researchers, the informed consent requirement for this study was waived by the Institutional Review Board.

Ethical approval

Institutional Review Board approval was obtained. The study protocol was approved by the ethics committee of the Second Affiliated Hospital of Zhejiang University, School of Medicine. The study was conducted according to the principle expressed in the Declaration of Helsinki.

Study subjects or cohorts overlap

None of the study subjects or cohorts has been previously reported.

Methodology

• retrospective

• observational

• performed at one institution

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Pei, Y., Chen, Y., Zhong, W. et al. Effect of computed tomography vs. computed tomography perfusion on mechanical thrombectomy outcomes within 6 hours. Eur Radiol (2024). https://doi.org/10.1007/s00330-023-10545-y

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