Thrombectomy in Patients With Ischemic Stroke Without Salvageable Tissue on CT Perfusion.

التفاصيل البيبلوغرافية
العنوان:	Thrombectomy in Patients With Ischemic Stroke Without Salvageable Tissue on CT Perfusion.
المؤلفون:	Broocks G; Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany.; Department of Neuroradiology, HELIOS Medical Center, Campus of MSH Medical School Hamburg, Schwerin, Germany (G.B.)., McDonough RV; Department of Radiology, University of Calgary, Alberta, Canada (R.V.M.)., Bechstein M; Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany., Klapproth S; Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany., Faizy TD; Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany., Schön G; Institute of Medical Biometry and Epidemiology (G.S.) University Medical Center Hamburg-Eppendorf, Germany., Kniep HC; Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany., Bester M; Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany., Hanning U; Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany., Kemmling A; Department of Diagnostic and Interventional Neuroradiology, University Hospital Marburg, Marburg, Germany (A.K.)., Zeleñák K; Department of Radiology, Comenius University's Jessenius Faculty of Medicine and University Hospital, Martin, Slovakia (K.Z.)., Fiehler J; Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany., Meyer L; Department of Diagnostic and Interventional Neuroradiology (G.B., R.V.M., M.B., S.K., T.D.F., H.C.K., M.B., U.H., J.F., L.M.), University Medical Center Hamburg-Eppendorf, Germany.
المصدر:	Stroke [Stroke] 2024 May; Vol. 55 (5), pp. 1317-1325. Date of Electronic Publication: 2024 Apr 04.
نوع المنشور:	Journal Article
اللغة:	English
بيانات الدورية:	Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 0235266 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1524-4628 (Electronic) Linking ISSN: 00392499 NLM ISO Abbreviation: Stroke Subsets: In Process; MEDLINE
أسماء مطبوعة:	Publication: 1998- : Baltimore, Md. : Lippincott Williams & Wilkins Original Publication: Dallas : American Heart Association
مستخلص:	Background: Computed tomography perfusion (CTP) imaging is regularly used to guide patient selection for mechanical thrombectomy (MT). However, the effect of MT in patients without salvageable tissue on CTP has not been investigated. The purpose of this study was to assess the effect of MT in patients with stroke without perfusion mismatch profiles. Methods: This observational study analyzed patients with ischemic stroke consecutively treated between March 1, 2015, and January 31, 2022, triaged by multimodal-computed tomography undergoing MT. CTP lesion-core mismatch profiles were defined using a mismatch volume/ratio of ≥10 mL/1.2, respectively. The primary end point was the rate of functional independence at 90 days, defined as the modified Rankin Scale score of 0 to 2. Recanalization was evaluated with the modified Thrombolysis in Cerebral Infarction scale. The effect of baseline variables on functional outcome was assessed using multivariable logistic regression analysis. Outcomes of patients with and without CTP-mismatch profiles were compared using 1:1 propensity score matching. Results: Of 724 patients who met the inclusion criteria of this retrospective observational study, 110 (15%) patients had no CTP mismatch and were analyzed. The median age was 74 (interquartile range, 62-80) years and 53% were women. Successful recanalization (modified Thrombolysis in Cerebral Infarction score, ≥2b) was achieved in 66% (73) and associated with functional independence at 90 days (adjusted odds ratio, 7.33 [95% CI, 1.22-43.70]; P =0.03). A significant interaction was observed between recanalization and age, as well as the extent of infarction, indicating MT to be most effective in patients <70 years and with a baseline Alberta Stroke Program Early Computed Tomography Score range between 3 and 7. These findings remained stable after propensity score matching, analyzing 152 matched pairs with similar rates of functional independence between patients with and without CTP-mismatch profiles (17% versus 23%; P =0.42). Conclusions: In patients without CTP-mismatch profiles defined according to the EXTEND (Extending the Time for Thrombolysis in Emergency Neurological Deficits) criteria, recanalization was associated with improved functional outcomes. This effect was associated with baseline Alberta Stroke Program Early Computed Tomography Score and age, but not with the time from onset to imaging. Competing Interests: Disclosures Dr Fiehler reports German Ministry of Science and Education, the German Ministry of Economy and Innovation, the German Research Foundation, the European Union, the Hamburgische Investitions—und Förderbank. Dr Kemmling reports Research collaboration agreement: Siemens Healthcare (company involved in computed tomography/magnetic resonance imaging distribution). Dr Kniep reports Educational presentation for Asklepios Kliniken, Consulting for EppData Gesellschaftmit beschränkter Haftung (GmbH). The other authors report no conflicts.
التعليقات:	Comment in: Stroke. 2024 May;55(5):1326-1328. (PMID: 38572633)
فهرسة مساهمة:	Keywords: infarction; ischemic stroke; perfusion; stroke; thrombectomy
تواريخ الأحداث:	Date Created: 20240404 Latest Revision: 20240422
رمز التحديث:	20240423
DOI:	10.1161/STROKEAHA.123.044916
PMID:	38572635
قاعدة البيانات:	MEDLINE

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تدمد:	1524-4628
DOI:	10.1161/STROKEAHA.123.044916