Outcomes of Symptomatic Anterior Large Vessel Occlusion by Initial Imaging Assessment Using Diffusion-Weighted Imaging Versus Noncontrast Computed Tomography.

BACKGROUND

We aimed to compare outcomes after stroke due to anterior circulation large vessel occlusion with initial imaging assessments using diffusion-weighted imaging (DWI) or noncontrast computed tomography (NCCT).

METHODS

Among 2399 patients with large vessel occlusion stroke in a prospective, multicenter registry, patients with (1) prestroke modified Rankin Scale scores 0 to 1, (2) occlusion of the internal carotid artery or M1 segment of the middle cerebral artery, and (3) onset-to-hospital-arrival time <6 hours were included. The primary effectiveness outcome was good functional outcome, defined as modified Rankin Scale scores 0 to 2 at 3 months. Safety outcomes included symptomatic intracranial hemorrhage. Intergroup biases were accounted for by mixed-effects multivariable modeling and inverse probability of treatment weighting.

RESULTS

A total of 343 patients (130 women [37.9%]; median age, 74 years [interquartile range, IQR, 66-82 years]) were analyzed. DWI-based assessment was performed in 217 patients, and NCCT-based assessment was performed in 126 patients. The DWI group showed a lower baseline National Institutes of Health Stroke Scale score (P<0.01) and lower Alberta Stroke Program Early CT Score (P<0.01) than the NCCT group. Frequency of endovascular therapy was lower in the DWI group (71.9%) than in the NCCT group (84.1%; P<0.01). Median hospital-arrival-to-arterial-puncture time was 55 minutes (IQR, 40-77.5 minutes) in the DWI group and 55 minutes (IQR, 35-80 minutes) in the NCCT group (P=0.89), with similar rates of successful recanalization (77.6% versus 76.4%, respectively; P=0.88). Frequency of good functional outcome was 47.0% in the DWI group and 41.3% in the NCCT group (adjusted odds ratio, 1.32; 95% CI, 0.49-3.55). Symptomatic intracranial hemorrhage was encountered in 2.8% in the DWI group and 1.6% in the NCCT group (P=0.71).

CONCLUSIONS

Potential difference in accuracy of ischemic damage assessment between the 2 modalities did not seem to affect outcomes of anterior circulation large vessel occlusion stroke.

REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02419794.