Abstract WMP2: Computed Tomography or Magnetic Resonance Perfusion Imaging Benefits Selection of Acute Ischemic Stroke Patients for Endovascular Treatment
Background: Perfusion imaging to guide selection of patients for endovascular treatment of acute ischemic stroke (AIS) remains controversial. CT and MR perfusion have been performed at our institution during evaluation of AIS in order to triage patients who are more likely to benefit from endovascular therapy. The purpose of this study was to compare the clinical outcome between patients who did and did not receive advanced perfusion imaging prior to treatment.
Methods: From April 2004 to July 2012, 330 patients with large vessel AIS were retrospectively reviewed and divided into three cohorts: 1) perfusion imaging followed by mechanical thrombectomy (MT) and/or intra-arterial thrombolysis (IAT) (n= 98), 2) no perfusion imaging followed by MT and/or IAT (n= 191) and 3) perfusion imaging without endovascular treatment (n = 41). Cohorts were compared based on neurologic improvement (≥4 point change in NIHSS), successful revascularization (TIMI 2-3), symptomatic intracranial hemorrhage (sICH), discharge modified rankin score (mRS) ≤3 and in-hospital mortality. Multivariate regression was performed to determine the predictive value of perfusion imaging prior to endovascular therapy.
Results: Of 289 treated patients, mean age was 67 and median initial NIHSS was 17. The treated groups were matched in baseline characteristics and had no difference in the outcomes of successful revascularization, discharge mRS≤3 and improvement in NIHSS. However, 10 of 98 with perfusion imaging expired compared to 48 of 191 without perfusion (p=0.01). Logistic regression showed patients who had perfusion imaging prior to endovascular therapy were less likely to die during hospitalization (OR = 0.267; 95% CI = 0.170, 0.364) or to develop sICH (OR = 0.269; CI = 0.182, 0.356) Other predictors of mortality included advanced age (OR= 1.08; CI = 1.04, 1.13) and high initial NIHSS (OR = 1.14; CI = 1.09, 1.19). There was no mortality difference between treated and untreated cohorts.
Conclusion: Patients who underwent CT or MR perfusion imaging prior to neurointervention for AIS were significantly less likely to suffer sICH or in-hospital mortality, providing evidence for the positive role of advanced imaging in selecting patients for endovascular treatment.
- © 2012 by American Heart Association, Inc.