Non-Contrast CT and CT-Angiogram for Late Window Ischemic Stroke Treatment Selection. (May 2020)

• Record Type: Journal Article
• Authors: Beaulieu, Marie-Claude; Nehme, Ahmad; Fortin, Francis; Karkri, Fatine; Daneault, Nicole; Deschaintre, Yan; Gioia, Laura C.; Jacquin, Grégory; Poppe, Alexandre Y.; Stapf, Christian; Odier, Céline
• Is Part Of: Canadian journal of neurological sciences. Volume 47:Number 3(2020)
• Page Start: 309
• Page End: 313
• Publication Date: 2020-05
• Subjects: Stroke, -- Endovascular treatment, -- Late window, -- Imaging; Neurology -- Periodicals; Nervous system -- Surgery -- Periodicals; Electronic journals; 616.8
• DOI: 10.1017/cjn.2020.15
• Languages: English
• ISSNs: 0317-1671

Abstract

ABSTRACT: Introduction: The benefit of late window endovascular treatment (EVT) for anterior circulation ischemic stroke has been demonstrated using perfusion-based neuroimaging. We evaluated whether non-contrast CT (NCCT) and CT-angiogram (CTA) alone can select late-presenting patients for EVT. Methods: We performed a retrospective comparison of all patients undergoing EVT at a single comprehensive stroke center from January 2016 to April 2017. Patients planned for EVT were divided into early (<6 hours from onset) and late (≥6 hours from onset or last time seen normal) window groups. Incidence of symptomatic hemorrhagic transformations (sHTs) at 24 hours and 3-month modified Rankin scores (mRSs) were compared. Results: During the study period, 204 (82%) patients underwent EVT in the early and 44 (18%) in the late window. Median (interquartile range) NIH Stroke Scale Score was similar between groups (early: 18 [15–23] vs. late: 17 [13–21]), as were median ASPECT scores (early: 9 [8–10] vs. late: 9 [7–9]). In the late window, 42 (95%) strokes were of unknown onset. Similar proportions of sHT occurred at 24 hours (early: 12 [6%] vs. late: 4 [9%], p = 0.43). At 3 months, the proportion of patients achieving functional independence (mRS 0–2) were comparable in the early (80/192 [42%]) and late (16/41 [39%]) windows ( p = 0.76). Conclusion: NCCT- and CTA-based patient selection led to similar functional independence outcomes and low proportions of sHT in the early and late windows. In centers without access to perfusion-based neuroimaging, this pragmatic approach could be safe, particularly for strokes of unknown onset.