Photo Credit: Mr. Suphachai Praserdumrongchai

The following is a summary of “Noncontrast CT Selected Thrombectomy vs Medical Management for Late-Window Anterior Large Vessel Occlusion,” published in the May 2024 issue of Neurology by Nguyen et al.

Uncertainties exist regarding using non-contrast computed tomography (NCCT) and CT angiography (CTA) to identify patients with large vessel occlusion (LVO) for endovascular therapy (EVT) within the late 6-hour to 24-hour stroke window.

Researchers conducted a retrospective study to compare the clinical outcomes of patients who encountered stroke selected for EVT based on NCCT findings in the extended time window with those who received only medical management.

They involved 66 sites in 10 countries and included consecutive patients with proximal anterior LVO stroke chosen for EVT by NCCT or medically managed. Patients presented within 6–24 hours last seen well (TSLW) (January 2014 to May 2022). The primary endpoint was the 90-day ordinal shift in the modified Rankin Scale (mRS) score. The inverse probability treatment weighting (IPTW) and multivariable methods were utilized.

The results showed 5,098 patients screened, 839 were included, with a median IQR of 75 (64–83) years; 455 (54.2%) were women. Of these, 616 (73.4%) underwent EVT by NCCT, and 223 (26.6%) were medically managed. In IPTW analyses, patients selected by NCCT for EVT had a more favorable 90-day ordinal mRS shift compared to those medically managed (OR 1.99, 95% CI 1.53–2.59; P<0.001). The EVT group also had higher rates of 90-day functional independence (mRS 0–2) (40.1% vs. 18.4%, OR 3.31, 95% CI 2.11–5.20; P<0.001). Although not statistically significant, the EVT group showed a nonsignificantly higher incidence of sICH (8.5% vs. 1.4%, OR 3.77, 95% CI 0.72–19.7, P=0.12). Additionally, mortality at 90 days was lower in the EVT compared to the medically managed group (23.9% vs. 32.3%, OR 0.61, 95% CI 0.45–0.83, P=0.002).

Investigators concluded that NCCT and CTA did not reliably identify patients with good outcomes for EVT in the extended time window compared to medical management.

Source: neurology.org/doi/10.1212/WNL.0000000000209324