Koizumi Satoshi, Kimura Toshikazu, Shojima Masaaki, Inoue Tomohiro
Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan; Department of Neurosurgery, The University of Tokyo, Tokyo, Japan.
Department of Neurosurgery, NTT Medical Center Tokyo, Tokyo, Japan.
World Neurosurg. 2018 Apr;112:e581-e587. doi: 10.1016/j.wneu.2018.01.091. Epub 2018 Feb 2.
In the treatment of acute ischemic stroke (AIS), patients need to be selected for mechanical thrombectomy (MT) in the acute phase. Selection criteria vary, however, depending on the patient's situation. This study investigated the effectiveness of a noncontrast computed tomography and symptom-based protocol for selecting patients for MT.
This retrospective study included 20 patients with AIS. The first 8 patients (earlier group) were screened by magnetic resonance imaging (MRI). Among the later 12 patients, MRI was deliberately skipped in 9, and major vessel occlusion was confirmed by digital subtraction angiography after meeting 4 criteria: 1) hospital arrival within 90 minutes from onset; 2) National Institutes of Health Stroke Scale score 9-25; 3) history or presence of atrial fibrillation; and 4) Alberta Stroke Program Early CT Score of 9-10. The clinical outcomes and time course were compared.
Among the later period group, 9 of 12 patients skipped MRI-based confirmation of large vessel occlusion. They underwent the direct angiography protocol, which had a 78% (7/9) positive predictive value for identifying large-vessel occlusion. In this group, National Institutes of Health Stroke Scale scores on the next day had significantly improved (median -8 points) compared with those at admission. Good functional outcome did not differ between the groups at 3 months.
Noncontrast computed tomography and symptom-based selection of MT to treat AIS can be useful for achieving better neurologic recovery in a subgroup of patients. This approach could broaden the use of MT.
