E-125 Patient selection for basilar occlusion stroke thrombectomy using conventional versus advanced imaging – an international multicenter investigation
Year: 2024
Type: conference-abstract
Abstract: Background Endovascular thrombectomy (EVT) is an effective treatment for acute ischemic strokes due to basilar artery occlusion; however, treatment benefit is variable and sensitive to radiographic characteristics. While advanced imaging modalities such as computed tomography perfusion (CTP) and magnetic resonance (MR) may be superior in identifying and quantifying infarcted and at-risk tissue, whether conventional imaging (non-contrast CT and CT angiography) is sufficient for patient selection is unclear. Methods This was an international multi-center retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR). Basilar EVT patients treated from 2013 to 2022 were identified. Patient demographics, medical history, and stroke characteristics were captured. Patients selected for treatment by advanced imaging (CTP or MR) were matched with those selected by conventional imaging based on propensity score matching (PSM) of all captured clinical variables. Primary outcome was functional independence at 90 days. Other outcomes include bedridden state or death at 90-days and symptomatic intracranial hemorrhage. Results 268 patients were identified. 150 patients were selected for basilar EVT by conventional imaging, 86 by CTP, and 32 by MR. Overall, patients selected by advanced imaging were significantly older than those selected by conventional imaging (median age 71 vs. 64 years, p=0.001); patient characteristics were otherwise similar between cohorts. After PSM for possible confounders, 90-day outcomes were similar between the two cohorts (p=0.56), with similar rates of functional independence (39.4% vs. 35.1%, p=0.65), bedridden state or death (40.4% vs. 44.7%, p=0.66), and symptomatic ICH (3.3% vs. 5.7%, p=0.49) for conventional and advanced imaging groups, respectively. Similar results were seen among patient subgroups who underwent EVT within or beyond 6 hours of stroke onset (p>0.05 for all endpoints). Patients selected for treatment by CTP or MR also had similar outcomes compared to their PSM controls (p>0.05 for all endpoints). Conclusions Selecting patients for basilar EVT using conventional versus advanced imaging did not result in different clinical outcomes. Conventional imaging appears sufficient for selecting basilar EVT patients in routine clinical practice, and the use of advanced imaging modalities may not confer a significant advantage. Disclosures H. Chen: None. M. Colasurdo: None. H. Matsukawa: None. C. Cunningham: None. I. Maier: None. S. Al Kasab: None. P. Jabbour: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: None. M. Psychogios: None. E. Samaniego: None. N. Goyal: None. S. Yoshimura: None. H. Cuellar: None. J. Grossberg: None. A. Alawieh: None. A. Alaraj: None. M. Ezzeldin: None. D. Romano: None. O. Tanweer: None. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Crosa: None. C. Matouk: None. M. Park: None. M. Levitt: None. W. Brinjikji: None. M. Moss: None. T. Dumont: None. E. Daglioglu: None. R. Williamson: None. P. Navia: None. R. De Leacy: None. S. Chowdhry: None. D. Altschul: None. A. Spiotta: 2; C; Penumbra, Terumo, RapidAI, Cerenovus. P. Kan: 1; C; Medtronic, Siemens, NIH (1U18EB029353–01). 2; C; Imperative Care, Stryker Neurovascular. 4; C; Vena Medical.
Authors: H Chen, M Colasurdo, H Matsukawa, C Cunningham, I Maier, S Al Kasab, P Jabbour, J Kim, S Wolfe, A Rai, R Starke, M Psychogios, E Samaniego, N Goyal, S Yoshimura, H Cuellar, J Grossberg, A Alawieh, A Alaraj, M Ezzeldin, D Romano, O Tanweer, J Mascitelli, I Fragata, A Polifka, F Siddiqui, J Osbun, R Crosa, C Matouk, M Park, M Levitt, W Brinjikji, M Moss, T Dumont, E Daglioglu, R Williamson, P Navia, R De Leacy, S Chowdhry, D Altschul, A Spiotta, P Kan
Institutions: National Institutes of Health, Georgetown University, MedStar Georgetown University Hospital, National Institute of Neurological Disorders and Stroke, Oregon Health and Science University Hospital, Medical University of South Carolina, Universitätsmedizin Göttingen, University of Göttingen, Thomas Jefferson University, Chonnam National University Hospital, West Virginia University, University of Miami Health System, University Hospital of Basel, University of Iowa, University of Tennessee Health Science Center, Semmes Murphey Foundation, Hyogo Medical University, Louisiana State University Health Sciences Center Shreveport, Emory University, University of Chicago, University of Houston, AOU San Giovanni di Dio e Ruggi d'Aragona, Baylor College of Medicine, The University of Texas at San Antonio Health Science Center, Universidade Nova de Lisboa, University of Florida, University of Michigan, Washington University in St. Louis, Yale University, University of Virginia, University of Washington, Mayo Clinic, Washington Regional Medical Center, University of Arizona, Ankara Bilkent City Hospital, Allegheny General Hospital, Hospital Universitario La Paz, Mount Sinai Health System, Endeavor Health, Albert Einstein College of Medicine, Montefiore Medical Center, The University of Texas Medical Branch at Galveston
Language: English
Subfield: Epidemiology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
Funders: Yale University, University of Miami, Emory University, Washington University in St. Louis, University of Washington, Georgetown University, Thomas Jefferson University, University of South Carolina, West Virginia University, Universitätsspital Basel, Universitätsmedizin Göttingen, Chonnam National University, Hyogo College of Medicine, Universidade Nova de Lisboa, National Institutes of Health, Health Science Center, University of Tennessee, University of Texas Health Science Center at San Antonio, LSU Health Shreveport
OpenAlex ID: W4400893617