Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

Rankin scores have very little discrimination and are way too gross in subjective measures to have any meaning at all. So I don't see much meaning in here at all.

Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry

 

1. Zeguang Ren1,
2. http://orcid.org/0000-0002-9374-7589Gaoting Ma2,
3. Maxim Mokin1,
4. Ashutosh P Jadhav3,
5. Baixue Jia2,
6. http://orcid.org/0000-0002-3277-6941Xu Tong2,
7. Clayton Bauer1,
8. Raynald Liu2,
9. Anxin Wang4,
10. Xuelei Zhang5,
11. Dapeng Mo2,
12. http://orcid.org/0000-0002-4909-7048Ning Ma2,
13. Feng Gao2,
14. Ligang Song2,
15. Xuan Sun2,
16. Xiaochuan Huo2,
17. Yiming Deng2,
18. Lian Liu2,
19. Gang Luo2,
20. Xiang Luo6,
21. Ya Peng7,
22. Liqiang Gui8,
23. Cunfeng Song9,
24. Jin Wu10,
25. Leyuan Wang11,
26. Chunlei Li12,
27. Tudor G Jovin13,
28. Yilong Wang4,14,
29. Yongjun Wang4,14,
30. Zhongrong Miao2
31. on behalf of ANGEL-ACT Study Group

1. Correspondence to Dr Zhongrong Miao, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing 100070, China; zhongrongm@163.com

Abstract

Backgroud The goal of this study was to determine if the choice of imaging paradigm performed in the emergency department influences the procedural or clinical outcomes after mechanical thrombectomy (MT).

Methods This is a retrospective comparative outcome study which was conducted from the ANGEL-ACT registry. Comparisons were made between baseline characteristics and clinical outcomes of patients with acute ischemic stroke undergoing MT with non-contrast head computed tomography (NCHCT) alone versus patients undergoing NCHCT plus non-invasive vessel imaging (NVI) (including CT angiography (with or without CT perfusion) and magnetic resonance angiography). The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included change in mRS score from baseline to 90 days, the proportions of mRS 0–1, 0–2, and 0–3, and dramatic clinical improvement at 24 hours. The safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH, and mortality within 90 days.

Results A total of 894 patients met the inclusion criteria; 476 (53%) underwent NCHCT alone and 418 (47%) underwent NCHCT + NVI. In the NCHCT alone group, the door-to-reperfusion time was shorter by 47 min compared with the NCHCT + NVI group (219 vs 266 min, P<0.001). Patients in the NCHCT alone group showed a smaller increase in baseline mRS score at 90 days (median 3 vs 2 points; P=0.004) after adjustment. There were no significant differences between groups in the remaining clinical outcomes.

Conclusions In patients selected for MT using NCHCT alone versus NCHCT + NVI, there were improved procedural outcomes and smaller increases in baseline mRS scores at 90 days.

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available to researchers on request for purposes of reproducing the results or replicating the procedure by directly contacting the corresponding author.

http://dx.doi.org/10.1136/neurintsurg-2021-017940

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Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available to researchers on request for purposes of reproducing the results or replicating the procedure by directly contacting the corresponding author.