Conventional versus advanced imaging selection for endovascular treatment of basilar artery occlusion strokes.

IF 4.5 3区医学 Q1 CLINICAL NEUROLOGY

European Stroke Journal Pub Date : 2025-08-28 DOI:10.1177/23969873251364973

Huanwen Chen, Marco Colasurdo, Hidetoshi Matsukawa, Conor Cunningham, Ilko Maier, Sami Al Kasab, Pascal Jabbour, Joon-Tae Kim, Stacey Quintero Wolfe, Ansaar Rai, Robert M Starke, Marios-Nikos Psychogios, Edgar A Samaniego, Nitin Goyal, Shinichi Yoshimura, Hugo Cuellar, Jonathan A Grossberg, Ali Alawieh, Ali Alaraj, Mohamad Ezzeldin, Daniele G Romano, Omar Tanweer, Justin Mascitelli, Isabel Fragata, Adam Polifka, Fazeel Siddiqui, Joshua Osbun, Roberto Crosa, Charles Matouk, Min S Park, Michael R Levitt, Waleed Brinjikji, Mark Moss, Travis Dumont, Ergun Daglioglu, Richard Williamson, Pedro Navia, Reade De Leacy, Shakeel Chowdhry, David J Altschul, Alejandro M Spiotta, Peter Kan

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引用次数: 0

Abstract

Introduction: Endovascular thrombectomy (EVT) is an effective treatment for basilar artery occlusion (BAO) stroke in select patients. While there is a growing body of literature suggesting that advanced imaging modalities such as computed tomography perfusion (CTP) and magnetic resonance (MR) may not be necessary for selecting anterior circulation large vessel occlusion stroke patients for EVT, whether advanced imaging may be superior to conventional imaging (non-contrast CT and CT angiography) in identifying good treatment candidates among BAO patients is less clear.

Patients and methods: This was a multicenter retrospective cohort study of BAO EVT patients treated from 2013 to 2022 in the Stroke Thrombectomy and Aneurysm Registry. Patients selected for EVT by advanced imaging (CTP or MR) were matched with those selected by conventional imaging using propensity score matching (PSM) accounting for possible confounders. Primary outcome was functional independence at 90 days. Other outcomes include bedridden state or death at 90-days and symptomatic intracranial hemorrhage (sICH).

Results: 268 patients were included. 150 patients were selected for BAO EVT by conventional imaging, 86 by CTP, and 32 by MR. Patients selected by advanced imaging were significantly older than those selected by conventional imaging (median age 71 vs 64 years, p = 0.001); patient characteristics were otherwise similar between cohorts. After PSM, 90-day outcomes were similar between the two cohorts (p = 0.56), with similar rates of functional independence (39.4% vs 35.1%, p = 0.65), bedridden state or death (40.4% vs 44.7%, p = 0.66), and sICH (3.3% vs 5.7%, p = 0.49) for conventional and advanced imaging groups, respectively. Results were similar across treatment time windows (all p > 0.05).

Conclusions: Selecting patients for basilar EVT using conventional versus advanced imaging did not result in different clinical outcomes, regardless of treatment time windows. Conventional imaging appears sufficient as a first-line tool for selecting basilar EVT patients in routine clinical practice.

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基底动脉闭塞性卒中血管内治疗的常规与先进影像学选择。

血管内取栓术（EVT）是治疗基底动脉闭塞（BAO）脑卒中的有效方法。虽然越来越多的文献表明，在选择前循环大血管闭塞卒中患者进行EVT时，可能不需要先进的成像方式，如计算机断层扫描灌注（CTP）和磁共振（MR），但在确定BAO患者中良好的治疗候选者方面，先进的成像是否优于传统成像（非对比CT和CT血管造影）尚不清楚。患者和方法：这是一项多中心回顾性队列研究，纳入了2013年至2022年在卒中血栓切除术和动脉瘤登记中接受治疗的BAO EVT患者。通过高级成像（CTP或MR）选择EVT的患者使用倾向评分匹配（PSM）与传统成像选择的患者进行匹配，考虑可能的混杂因素。主要终点是90天的功能独立。其他结局包括90天卧床或死亡和症状性颅内出血（siich）。结果：纳入268例患者。常规影像学选择BAO EVT患者150例，CTP选择86例，mr选择32例，晚期影像学选择的患者明显大于常规影像学选择的患者（中位年龄71岁vs 64岁，p = 0.001）；患者特征在其他方面在队列之间相似。PSM后，两个队列的90天结果相似（p = 0.56），常规组和高级影像学组的功能独立性（39.4% vs 35.1%, p = 0.65）、卧床状态或死亡（40.4% vs 44.7%, p = 0.66）和siich （3.3% vs 5.7%, p = 0.49）的发生率相似。不同治疗时间窗的结果相似（p < 0.05）。结论：无论治疗时间窗如何，采用常规影像学和先进影像学选择基底动脉EVT患者不会导致不同的临床结果。在常规临床实践中，常规影像学作为选择基底静脉血栓患者的一线工具是足够的。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

European Stroke Journal Multiple-

CiteScore

7.50

自引率

6.60%

发文量

102

期刊介绍： Launched in 2016 the European Stroke Journal (ESJ) is the official journal of the European Stroke Organisation (ESO), a professional non-profit organization with over 1,400 individual members, and affiliations to numerous related national and international societies. ESJ covers clinical stroke research from all fields, including clinical trials, epidemiology, primary and secondary prevention, diagnosis, acute and post-acute management, guidelines, translation of experimental findings into clinical practice, rehabilitation, organisation of stroke care, and societal impact. It is open to authors from all relevant medical and health professions. Article types include review articles, original research, protocols, guidelines, editorials and letters to the Editor. Through ESJ, authors and researchers have gained a new platform for the rapid and professional publication of peer reviewed scientific material of the highest standards; publication in ESJ is highly competitive. The journal and its editorial team has developed excellent cooperation with sister organisations such as the World Stroke Organisation and the International Journal of Stroke, and the American Heart Organization/American Stroke Association and the journal Stroke. ESJ is fully peer-reviewed and is a member of the Committee on Publication Ethics (COPE). Issues are published 4 times a year (March, June, September and December) and articles are published OnlineFirst prior to issue publication.