Association of initial imaging modality and futile recanalization after thrombectomy
| Autor: | Steven D. Hajdu, Christian Maegerlein, Urs Fischer, Simon Jung, Pascal J. Mosimann, David J. Seiffge, Vincent Costalat, Pasquale Mordasini, Johannes Kaesmacher, Laurent Pierot, Jan Gralla, Thomas Raphael Meinel, Marta Olivé-Gadea, Marcel Arnold, Joanna D. Schaafsma, Martina Goeldlin |
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| Přispěvatelé: | Bern University Hospital [Berne] (Inselspital), Lausanne University Hospital, Vall d'Hebron University Hospital [Barcelona], Département de Neuroradiologie[Montpellier], Hôpital Gui de Chauliac [Montpellier]-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Université Montpellier 1 (UM1)-Université de Montpellier (UM), Université de Montpellier (UM), Centre Hospitalier Universitaire de Reims (CHU Reims), Toronto Western Hospital, Université Montpellier 1 (UM1)-Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)-Hôpital Gui de Chauliac [Montpellier]-Université de Montpellier (UM) |
| Rok vydání: | 2020 |
| Předmět: |
MESH: Cerebral Hemorrhage
Male Multivariate analysis MESH: Registries MESH: Treatment Failure 030218 nuclear medicine & medical imaging MESH: Magnetic Resonance Imaging 0302 clinical medicine MESH: Aged 80 and over Modified Rankin Scale Image Processing Computer-Assisted MESH: Thrombectomy Registries Treatment Failure 610 Medicine & health Stroke MESH: Treatment Outcome Thrombectomy MESH: Aged Aged 80 and over MESH: Middle Aged Middle Aged MESH: Image Processing Computer-Assisted Magnetic Resonance Imaging ddc Treatment Outcome [SDV.NEU]Life Sciences [q-bio]/Neurons and Cognition [q-bio.NC] Female MESH: Tomography X-Ray Computed Algorithms MESH: Algorithms [SDV.MHEP.CHI]Life Sciences [q-bio]/Human health and pathology/Surgery Article MESH: Stroke 03 medical and health sciences Text mining medicine Humans In patient Aged Cerebral Hemorrhage Retrospective Studies MESH: Humans business.industry MESH: Retrospective Studies Odds ratio medicine.disease Confidence interval MESH: Male Mechanical thrombectomy [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie Neurology (clinical) Nuclear medicine business Tomography X-Ray Computed MESH: Female 030217 neurology & neurosurgery |
| Zdroj: | Neurology Neurology, American Academy of Neurology, 2020, 95 (17), pp.e2331-e2342. ⟨10.1212/WNL.0000000000010614⟩ Meinel, Thomas Raphael; Kaesmacher, Johannes; Mosimann, Pascal John; Seiffge, David Julian; Jung, Simon; Mordasini, Pasquale; Arnold, Marcel; Goeldlin, Martina; Hajdu, Steven D; Olivé-Gadea, Marta; Maegerlein, Christian; Costalat, Vincent; Pierot, Laurent; Schaafsma, Joanna D; Fischer, Urs; Gralla, Jan (2020). Association of initial imaging modality and futile recanalization after thrombectomy. Neurology, 95(17), e2331-e2342. Lippincott Williams & Wilkins 10.1212/WNL.0000000000010614 article-version (Version of Record) 3 |
| ISSN: | 1526-632X 0028-3878 |
| DOI: | 10.1212/WNL.0000000000010614⟩ |
| Popis: | ObjectiveTo test the hypothesis that selection by initial imaging modality (MRI vs CT) is associated with rate of futile recanalizations (FRs) after mechanical thrombectomy (MT), we assessed this association in a multicenter, retrospective observational registry (BEYOND-SWIFT [Registry for Evaluating Outcome of Acute Ischemic Stroke Patients Treated With Mechanical Thrombectomy], NCT03496064).MethodsIn 2,011 patients (49.7% female, median age 73 years [61–81]) included between 2009 and 2017, we performed univariate and multivariate analyses regarding the occurrence of FR. FRs were defined as 90-day modified Rankin Scale (mRS) score 4–6 despite successful recanalization in patients selected by MRI (n = 690) and CT (n = 1,321) with a sensitivity analysis considering only patients with mRS 5–6 as futile.ResultsMRI as compared to CT resulted in similar rates of subsequent MT (adjusted odds ratio [aOR] 1.048, 95% confidence interval [CI] 0.677–1.624). Rates of FR were as follows: 571/1,489 (38%) FR mRS 4–6 including 393/1,489 (26%) FR mRS 5–6. CT-based selection was associated with increased rates of FRs compared to MRI (44% [41%–47%] vs 29% [25%–32%], p < 0.001; aOR 1.77 [95% CI 1.25–2.51]). These findings were robust in sensitivity analysis. MRI-selected patients had a delay of approximately 30 minutes in workflow metrics in real-world university comprehensive stroke centers. However, functional outcome and mortality were more favorable in patients selected by MRI compared to patients selected with CT.ConclusionsCT selection for MT was associated with an increased risk of FRs as compared to MRI selection. Efforts are needed to shorten workflow delays in MRI patients. Further research is needed to clarify the role of the initial imaging modality on FR occurrence and to develop a reliable FR prediction algorithm. |
| Databáze: | OpenAIRE |
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