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Advanced Neuroimaging in Stroke Patient Selection for Mechanical Thrombectomy
Georgios Tsivgoulis1,2,3,4,5,6,7,8, Aristeidis H Katsanos1,2,3,4,5,6,7,8, Peter D Schellinger1,2,3,4,5,6,7,8
1From the Second Department of Neurology, Attikon Hospital, National and Kapodistrian University of Athens, Greece (G.T., A.H.K., L.P.).
Stroke
|December 21, 2018
Summary
Advanced neuroimaging significantly improves outcomes for acute ischemic stroke patients undergoing mechanical thrombectomy (MT). This method aids in patient selection and prognosis prediction, regardless of time since symptom onset.
Area of Science:
- Neurology
- Radiology
- Medical Imaging
Background:
- Clinical equipoise exists regarding advanced imaging for selecting acute ischemic stroke patients for mechanical thrombectomy (MT) within 6 hours.
- Emerging evidence highlights advanced neuroimaging as a crucial, time-independent prognostic factor.
Purpose of the Study:
- To systematically review and meta-analyze randomized clinical trials evaluating advanced neuroimaging's impact on MT patient selection.
- To assess the effect on 3-month functional independence, favorable functional outcome, all-cause mortality, and functional improvement.
Main Methods:
- Systematic review and meta-analysis of 10 randomized clinical trials (2227 patients).
- Comparison of outcomes between patients selected with advanced imaging (perfusion imaging penumbra) and those without.
- Evaluation of functional independence (mRS 0-2), favorable outcome (mRS 0-1), mortality, and functional improvement (ordinal mRS analysis).
Main Results:
- Studies using advanced neuroimaging showed significantly higher treatment effects of MT on functional independence (OR 3.79 vs 1.89) and favorable functional outcome (OR 3.16 vs 1.75).
- Improved functional improvement was observed with advanced imaging (common OR 2.66 vs 1.60).
- Higher pooled rates of successful reperfusion were noted with advanced imaging; no differences in mortality or hemorrhage rates were found.
Conclusions:
- Advanced neuroimaging-based patient selection for MT is associated with improved clinical outcomes in acute ischemic stroke.
- The use of advanced neuroimaging for selection and prognosis in MT candidates should be time-independent.
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