CT Perfusion Outcomes After Endovascular Therapy in Stroke

Study Questions:

Does computed tomographic perfusion (CTP) selection improve endovascular therapy outcomes compared with noncontrast CT alone?

Methods:

The authors assessed the outcome of anterior circulation stroke patients undergoing stent-retriever thrombectomy at a tertiary care center between September 2010 and March 2016. Patients undergoing CTP were compared with those with noncontrast CT alone. The primary outcome was the shift in the 90-day modified Rankin scale (mRS).

Results:

Of a total of 602 patients, CTP was used in 365. Use of CTP was associated with a favorable 90-day mRS shift (adjusted odds ratio, 1.49; 95% confidence interval, 1.06-2.09; p = 0.02), higher rates of good outcomes (90-day mRS score 0-2: 52.9% vs. 40.4%; p = 0.005), greater likelihood of modified Thrombolysis in Cerebral Infarction-3 reperfusion (54.8% vs. 40.1%; p < 0.001), and lower mortality (16.6% vs. 26.8%; p = 0.005).

Conclusions:

CTP selection is associated with a favorable mRS shift in patients undergoing stent-retriever thrombectomy.

Perspective:

The optimal initial imaging strategy for guiding interventional therapy for stroke continues to be debated. Patients undergoing CTP in this study were younger and had less comorbidities, and it is unclear if the better outcome in this group related to these factors or to improved case selection secondary to use of a better imaging modality. Other observational studies have not corroborated the findings of this study, and randomized controlled trials are needed to define the optimal imaging strategy in this population.


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