From the Department of Radiology (H.K., S.G., C.B., M.A., R.K., W.B., D.F.K.), Mayo Clinic, Rochester, MN; College of Medicine (H.K.), Central Michigan University, Mount Pleasant; Department of Radiology (G.A.), Massachusetts General Hospital, Boston; Department of Neurology (H.T.), Medical College of Wisconsin, Milwaukee; Department of Neurologic Surgery (R.K.), Mayo Clinic, Rochester, MN; Department of Radiology and Neurosurgery (J.J.H.), Stanford University, CA; and Department of Neurology (A.A.R.), Mayo Clinic, Rochester, MN.
Neurology. 2023 May 30;100(22):e2304-e2311. doi: 10.1212/WNL.0000000000207262. Epub 2023 Mar 29.
Patients with acute ischemic stroke (AIS) treated with endovascular thrombectomy (EVT) in the late window (6-24 hours) can be evaluated with CT perfusion (CTP) or with noncontrast CT (NCCT) only. Whether outcomes differ depending on the type of imaging selection is unknown. We conducted a systematic review and meta-analysis comparing outcomes between CTP and NCCT for EVT selection in the late therapeutic window.
This study is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses 2020 guidelines. A systematic literature review of the English language literature was conducted using Web of Science, Embase, Scopus, and PubMed databases. Studies focusing on late-window AIS undergoing EVT imaged through CTP and NCCT were included. Data were pooled using a random-effects model. The primary outcome of interest was rate of functional independence, defined as modified Rankin scale 0-2. The secondary outcomes of interest included rates of successful reperfusion, defined as thrombolysis in cerebral infarction 2b-3, mortality, and symptomatic intracranial hemorrhage (sICH).
Five studies with 3,384 patients were included in our analysis. There were comparable rates of functional independence (odds ratio [OR] 1.03, 95% CI 0.87-1.22; = 0.71) and sICH (OR 1.09, 95% CI 0.58-2.04; = 0.80) between the 2 groups. Patients imaged with CTP had higher rates of successful reperfusion (OR 1.31, 95% CI 1.05-1.64; = 0.015) and lower rates of mortality (OR 0.79, 95% CI 0.65-0.96; = 0.017).
Although recovery of functional independence after late-window EVT was not more common in patients selected by CTP when compared with patients selected by NCCT only, patients selected by CTP had lower mortality.
在晚期治疗窗口（6-24 小时）接受血管内血栓切除术（EVT）治疗的急性缺血性脑卒中（AIS）患者可通过 CT 灌注（CTP）或仅非对比 CT（NCCT）进行评估。尚不清楚根据成像选择的类型，结局是否存在差异。我们进行了一项系统评价和荟萃分析，比较了晚期治疗窗口中 EVT 选择的 CTP 和 NCCT 之间的结局。
本研究根据 2020 年系统评价和荟萃分析首选报告项目进行报告。使用 Web of Science、Embase、Scopus 和 PubMed 数据库对英文文献进行了系统文献回顾。纳入研究的晚期 AIS 患者接受 CTP 和 NCCT 成像的 EVT。使用随机效应模型汇总数据。主要结局是功能独立性的发生率，定义为改良 Rankin 量表 0-2 分。次要结局包括成功再灌注的发生率，定义为血栓切除术脑梗死 2b-3 级；死亡率和症状性颅内出血（sICH）。
纳入我们分析的五项研究共 3384 例患者。两组间功能独立性的发生率相当（优势比[OR]1.03，95%置信区间[CI]0.87-1.22； = 0.71）和 sICH 发生率（OR 1.09，95%CI 0.58-2.04； = 0.80）。接受 CTP 成像的患者成功再灌注的发生率更高（OR 1.31，95%CI 1.05-1.64； = 0.015），死亡率更低（OR 0.79，95%CI 0.65-0.96； = 0.017）。
尽管与仅通过 NCCT 选择的患者相比，通过 CTP 选择的晚期窗口 EVT 后功能独立性恢复并不更常见，但通过 CTP 选择的患者死亡率更低。
