Abstract WMP10: Effect Of Imaging Selection Paradigms On Endovascular Thrombectomy Outcomes In Acute Ischemic Stroke Patients With Large Vessel Occlusion: A Pooled Analysis Of The Devt And Rescue Bt Randomized Clinical Trials

Abstract

Background and Purpose: The study aimed to assess the effect of basic imaging (noncontrast computed tomography (NCCT) with or without computed tomographic angiography (CTA)) versus advanced imaging (magnetic resonance imaging (MRI) or computed tomography perfusion (CTP)) on clinical outcomes following thrombectomy in stroke patients with large vessel occlusion (LVO) in the early and extended windows using a pooled analysis of randomized controlled trials. Methods: Patients from two randomized controlled trials with occlusion of the intracranial internal carotid artery or proximal middle cerebral artery (M1/M2 segments) were categorized according to baseline imaging modality (basic versus advanced) as well as treatment time window (early: 0-6 hours versus extended: 6-24 hours from last known well to puncture). The primary outcome was the proportion of patients with functional independence (modified Rankin scale score of 0-2) at 90 days. Multivariable Poisson regression analysis was performed to determine the association between imaging selection modality and outcomes after EVT at each time windows. Results: A total of 1182 patients were included in this cohort analysis, with 648 in the early (471 with basic imaging versus 177 advanced imaging) and 534 in the extended (222 basic imaging versus 312 advanced imaging) time window. There were no differences in 90-day functional independence between the advanced and basic imaging groups in either time windows (early window: adjusted relative risk, 0.95 (95% confidence interval, 0.80-1.11), P =0.49; extended window: adjusted relative risk, 0.98 (95% confidence interval, 0.82-1.17), P =0.83). Conclusions: In this post-hoc analysis of two randomized clinical trial pooled data involving patients with LVO stroke, there was no association between imaging selection modality and clinical or safety outcomes for patients undergoing thrombectomy in either the early or extended windows. Our study adds to the growing body of literature simpler imaging paradigms to assess thrombectomy eligibility across both the early and extended time windows.