Impact of RAPID-Based Patient Selection on Endovascular Therapy Outcomes in Acute Ischemic Stroke: A Retrospective Comparative Study.

Abstract

Objective: Perfusion imaging is widely used in acute ischemic stroke to guide endovascular thrombectomy (EVT). This study evaluated clinical outcomes among patients selected for EVT using perfusion software-based analysis compared with those selected without it.

Methods: We conducted a retrospective comparative analysis of patients with large- or medium-vessel occlusion who underwent EVT between 2024 and 2025. Patients were categorized into a perfusion software group (RAPID implementation period) and a non-perfusion software group (non-RAPID period) based on the use of RAPID imaging software (iSchemaView, Menlo Park, CA, USA). The primary outcome was the proportion of patients achieving a good clinical outcome at 90 days, defined as a modified Rankin Scale (mRS) score of 0-3. Secondary outcomes included a shift analysis of mRS scores, procedural time metrics, all hemorrhagic events including symptomatic intracerebral hemorrhage (sICH), and 90-day mortality.

Results: A total of 54 patients were included (RAPID implementation period, 26; non-RAPID period, 28). At 90 days, the proportion of patients achieving a good outcome (mRS 0-3) was similar between the RAPID implementation period group and the non-RAPID period group (50.0% vs. 46.4%; P = 0.72). In the ordinal shift analysis of mRS scores, there was no significant difference in the overall distribution between groups (common odds ratio, 0.91; 90% confidence interval [CI], 0.41-1.99; P = 0.84). The median time from hospital arrival to groin puncture was also similar-45 min (interquartile range [IQR], 40-58) versus 46 min (IQR, 39-63; P = 0.96). The incidences of any intracerebral hemorrhage (30.8% vs. 32.1%), sICH (0% vs. 3.6%), and 90-day mortality (15.0% vs. 7.1%) were likewise comparable between the RAPID and non-RAPID periods.

Conclusion: These findings suggest that automated, perfusion-based patient selection enhances workflow standardization and can be seamlessly integrated into acute stroke management to optimize both speed and safety.