Conventional versus advanced imaging selection for endovascular treatment of basilar artery occlusion strokes.
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Chen Huanwen, Colasurdo Marco, Matsukawa Hidetoshi, Cunningham Conor, Maier Ilko, Al Kasab Sami, Jabbour Pascal, Kim Joon-Tae, Wolfe Stacey Quintero, Rai Ansaar, Starke Robert M, Psychogios Marios-Nikos, Samaniego Edgar A, Goyal Nitin, Yoshimura Shinichi, Cuellar Hugo, Grossberg Jonathan A, Alawieh Ali, Alaraj Ali, Ezzeldin Mohamad, Romano Daniele G, Tanweer Omar, Mascitelli Justin, Fragata Isabel, Polifka Adam, Siddiqui Fazeel, Osbun Joshua, Crosa Roberto, Matouk Charles, Park Min S, Levitt Michael R, Brinjikji Waleed, Moss Mark, Dumont Travis, Daglioglu Ergun, Williamson Richard, Navia Pedro, Leacy Reade De, Chowdhry Shakeel, Altschul David J, Spiotta Alejandro M, Kan Peter
Аннотация
PATIENTS AND METHODS: This was a multicenter retrospective cohort study of BAO EVT patients treated from 2013 to 2022 in the Stroke Thrombectomy and Aneurysm Registry. Patients selected for EVT by advanced imaging (CTP or MR) were matched with those selected by conventional imaging using propensity score matching (PSM) accounting for possible confounders. Primary outcome was functional independence at 90 days. Other outcomes include bedridden state or death at 90-days and symptomatic intracranial hemorrhage (sICH).
RESULTS: 268 patients were included. 150 patients were selected for BAO EVT by conventional imaging, 86 by CTP, and 32 by MR. 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, 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 sICH (3.3% vs 5.7%, p = 0.49) for conventional and advanced imaging groups, respectively. Results were similar across treatment time windows (all p > 0.05).
CONCLUSIONS: Selecting patients for basilar EVT using conventional versus advanced imaging did not result in different clinical outcomes, regardless of treatment time windows. Conventional imaging appears sufficient as a first-line tool for selecting basilar EVT patients in routine clinical practice.