Deans' stroke musings: Stroke imaging prior to thrombectomy in the late window results from a pooled multicentre analysis

I don't know what stroke researchers are doing but they most assuredly are not solving stroke to get survivors 100% recovered. And that is all because we have NO leadership and NO strategy since survivors are not in charge. Researchers should be following the strategy for 100% recovery(that needs to be created yet.).

Stroke imaging prior to thrombectomy in the late window results from a pooled multicentre analysis

http://orcid.org/0000-0001-9550-8197Mohammed A Almekhlafi1,
John Thornton2,
Ilaria Casetta3,
Mayank Goyal4,
Stefania Nannoni5,
Darragh Herlihy6,
Enrico Fainardi7,
Sarah Power8,
Valentina Saia9,
Aidan Hegarty6,
Giovanni Pracucci10,
Andrew Demchuk4,
Salvatore Mangiafico11,
Karl Boyle6,
Patrik Michel5,
Fouzi Bala4,
Rubina Gill4,
Andrea Kuczynski12,
Ayolla Ademola4,
Michael D Hill13,
Danilo Toni14,
Sean Murphy15,
http://orcid.org/0000-0002-2719-3012Beom Joon Kim16,
Bijoy K Menon17
for the Selection Of Late-window Stroke for Thrombectomy by Imaging Collateral Extent (SOLSTICE) Consortium

Correspondence to Dr Mohammed A Almekhlafi, Foothills Medical Centre, Calgary, Canada; mohammed.almekhlafi1@ucalgary.ca

Abstract

Background and purpose Collateral assessment using CT angiography is a promising modality for selecting patients for endovascular thrombectomy (EVT) in the late window (6–24 hours). The outcome of these patients compared with those selected using perfusion imaging is not clear.

Methods We pooled data from seven trials and registries of EVT-treated patients in the late-time window. Patients were classified according to the baseline imaging into collateral imaging alone (collateral cohort) and perfusion plus collateral imaging (perfusion cohort). The primary outcome was the proportion of patients achieving independent 90-day functional outcome (modified Rankin Scale ‘mRS’ 0–2). We used the propensity score–weighting method to balance important predictors between the cohorts.

Results In 608 patients, the median onset/last-known-well to emergency arrival time was 8.8 hours and 53.2% had wake-up strokes. Both cohorts had collateral imaging and 379 (62.3%) had perfusion imaging. Independent functional outcome was achieved in 43.1% overall: 168/379 patients (45.5%) in the perfusion cohort versus 94/214 (43.9%) in the collateral cohort (p=0.71). A logistic regression model adjusting for inverse-probability-weighting showed no difference in 90-day mRS score of 0–2 among the perfusion versus collateral cohorts (adjusted OR 1.05, 95% CI 0.69 to 1.59, p=0.83) or in a favourable shift in 90-day mRS (common adjusted OR 1.01, 95% CI 0.69 to 1.47, p=0.97).

Conclusion This pooled analysis of late window EVT showed comparable functional outcomes in patients selected for EVT using collateral imaging alone compared with patients selected using perfusion and collateral imaging.

PROSPERO registration number CRD42020222003.