Both Simple, Advanced Imaging Can Predict Best Candidates for Thrombectomy

February 1, 2020
Both simple and advanced CT were effective in accurately predicting which patients who experienced a stroke would benefit from endovascular thrombectomy, according to a study published in the Annals of Neurology. “Endovascular thrombectomy has revolutionised the treatment for patients with acute stroke presenting with large vessel occlusion,” said lead author Amrou Sarraj, MD, University of Texas Health Institute for Stroke and Cerebrovascular Disease, Houston, Texas. “Different imaging techniques are used to identify patients who may benefit from this treatment. However, how these imaging profiles correlate with each other and with the stroke outcomes is unknown.” The Optimising Patient Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT) study included 361 patients, many who had favourable imaging results on both CT and CT perfusion. Patients with favourable imaging on both modalities had significantly higher odds of receiving endovascular therapy and higher 90-day functional independence rates after recovery (58%). Even when the 2 imaging modalities disagreed, the functional and safety outcomes were reasonable (38% achieved functional independence), which was better than the patients who did not receive thrombectomy. Patients with an unfavorable result on CT perfusion imaging, but favourable on simple CT, had higher rates of symptomatic haemorrhage in the brain tissue and death after stroke. Patients with unfavourable imaging profiles on both modalities had very poor outcomes. “While best outcomes were observed in patients with a favourable profile on both imaging modalities, patients who had a favourable profile on at least 1 imaging modality also achieved reasonable outcomes,” said Dr. Sarraj. The ongoing international phase 3 randomised SELECT 2 trial, also led by Dr. Sarraj, will assess the efficacy and safety of thrombectomy procedure in patients with unfavourable profile on 1 or both imaging modalities. Reference: https://onlinelibrary.wiley.com/doi/10.1002/ana.25669 SOURCE: University of Texas Health Science Center