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Neuroradiology

Erschienen in:

01.03.2024 | Interventional Neuroradiology

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

verfasst von: Chun-Hsien Lin, Bruce Ovbiagele, David S. Liebeskind, Jeffrey L. Saver, Meng Lee

Erschienen in: Neuroradiology | Ausgabe 5/2024

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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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Titel: Brain imaging prior to thrombectomy in the late window of large vessel occlusion ischemic stroke: a systematic review and meta-analysis
verfasst von: Chun-Hsien Lin
Bruce Ovbiagele
David S. Liebeskind
Jeffrey L. Saver
Meng Lee
Publikationsdatum: 01.03.2024
Verlag: Springer Berlin Heidelberg
Erschienen in: Neuroradiology / Ausgabe 5/2024
Print ISSN: 0028-3940
Elektronische ISSN: 1432-1920
DOI: https://doi.org/10.1007/s00234-024-03324-z

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