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  • Choice of Pretreatment Neuroimaging Impacts Clinical Outcomes Following Mechanical Thrombectomy

    Final Number:

    Sitara Koneru BA; Shazli Khan BS; Jaclyn Mueller; Samar Sheriff; Syed Fazal Zaidi

    Study Design:

    Subject Category:
    Ischemic Stroke

    Meeting: AANS/CNS Cerebrovascular Section 2018 Annual Meeting

    Introduction: Most MT trials required advanced neuroimaging including either CT or MR based angiography and perfusion for patient selection prior to randomization. However, in practice, centers may offer MT based on favorable findings (ASPECT score > 6) on non-contrast head CT (HCT) alone. We compared outcomes between patients who underwent MT based on HCT alone versus additional neuroimaging (HCT+).

    Methods: Case records of all patients who underwent MT at our center between Jan 2014 – Jun 2017 were reviewed. Patient demographics, presentation, pretreatment scan findings, treatment times and clinical outcomes were compared. Favorable outcome is defined as mRS of 2 or less at 90-days.

    Results: A total of 249 patients were identified, of which 50.2% were women. There were 85 (34.1%) patients who underwent MT based on findings on HCT alone; while the remaining 164 (65.9%) also underwent either CTA (88/249; 35.9%), CTA plus CTP (63/249; 25.7%) or MRI brain (9/249; 3.7%) prior to MT. Median age (72 vs. 70, p=0.2) and baseline ASPECT scores (8.5 vs. 9, p=0.9) were comparable between the HCT alone and HCT+ groups. The HCT alone patients had a higher NIHSS (20 vs. 16, p<0.01), however presented earlier with faster onset-to-recanalization (279 vs. 488 minutes, p=0.05). Procedure time (43.6 vs 45.5, p=0.8) and TICI 2b/3 recanalization (77.6 vs 80.5, p=0.5) were comparable. A significant trend towards a more favorable outcome in the HCT+ group was noted (28.7% vs 42.4%, p=0.04).

    Conclusions: Our findings suggest that only HCT (ASPECT score) based selection could be suboptimal when compared to more advanced imaging for MT patient selection. Further prospective studies are warranted.

    Patient Care: This abstract addresses the outcomes of mechanical thrombectomy related to choice of neuroimaging. Currently, it is not well known or studied whether the benefits of additional neuroimaging, such as CT or MR based angiography, CT perfusion studies, and MRI, outweigh the associated risks, such as slower onset to recanalization time. Currently, there is a gap in professional knowledge in knowing if and when additional neuroimaging can be beneficial to a patient and their clinical outcomes. Understanding the benefits and associated risks can help guide physicians in deciding which neuroimaging is best for their patient thereby improving patient outcomes.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Describe the importance and value of additional neuroimaging in predicting the outcome following mechanical thrombectomy 2) Understand factors that should be considered if and when obtaining additional imaging


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