Advanced modality imaging evaluation in acute ischemic stroke may lead to delayed endovascular reperfusion therapy without improvement in clinical outcomes.
Advanced modality imaging evaluation in acute ischemic stroke may lead to delayed endovascular reperfusion therapy without improvement in clinical outcomes.
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DOI：
10.1136/neurintsurg-2012-010512
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发表时间：
2013-05
影响因子：
4.8
通讯作者：
Gupta R
中科院分区：
文献类型：
--
作者：
Sheth KN;Terry JB;Nogueira RG;Horev A;Nguyen TN;Fong AK;Gandhi D;Prabhakaran S;Wisco D;Glenn BA;Tayal AH;Ludwig B;Hussain MS;Jovin TG;Clemmons PF;Cronin C;Liebeskind DS;Tian M;Gupta R
先进的神经成像技术可以改善患者对血管内卒中治疗的选择，但也可能延迟再灌注时间。我们在一个多中心队列中研究了CT灌注成像（CTP）或MRI与非对比CT （NCT）的效果。这是一项对10个中风中心的回顾性研究，这些中心选择患者进行血管内治疗，使用机构协议。由于只使用了非身份信息，因此获得了每个机构审查委员会的批准。我们收集了人口统计学和放射学数据，选定的时间间隔和结果数据。采用方差分析（ANOVA）比较各组（NCT、CTP和MRI）。进行二元logistic回归分析以确定与良好临床结果相关的因素。对556例患者进行分析。平均年龄66±15岁，美国国立卫生研究院卒中量表评分中位数为18分（IQR 14-22）。286例（51%）患者使用NCT， 190例（34%）患者使用CTP， 80例（14%）患者使用MRI。与CTP（114分钟，IQR(81-152)）或MRI（124分钟，IQR(87-165)）相比，NCT患者的腹股沟穿刺中位时间（61分钟，IQR(40-117)）明显较低。两组患者的临床结局、出血率或最终梗死面积均无差异。目前的回顾性研究表明，多模态成像可能与延迟治疗有关，而不能降低出血率或改善临床结果。这一探索性分析表明，前瞻性随机研究有理由支持先进模式成像在改善临床结果方面优于NCT的假设。
Advanced neuroimaging techniques may improve patient selection for endovascular stroke treatment but may also delay time to reperfusion. We studied the effect of advanced modality imaging with CT perfusion (CTP) or MRI compared with non-contrast CT (NCT) in a multicenter cohort. This is a retrospective study of 10 stroke centers who select patients for endovascular treatment using institutional protocols. Approval was obtained from each institution's review board as only de-identified information was used. We collected demographic and radiographic data, selected time intervals, and outcome data. ANOVA was used to compare the groups (NCT vs CTP vs MRI). Binary logistic regression analysis was performed to determine factors associated with a good clinical outcome. 556 patients were analyzed. Mean age was 66±15 years and median National Institutes of Health Stroke Scale score was 18 (IQR 14–22). NCT was used in 286 (51%) patients, CTP in 190 (34%) patients, and MRI in 80 (14%) patients. NCT patients had significantly lower median times to groin puncture (61 min, IQR (40–117)) compared with CTP (114 min, IQR (81–152)) or MRI (124 min, IQR (87–165)). There were no differences in clinical outcomes, hemorrhage rates, or final infarct volumes among the groups. The current retrospective study shows that multimodal imaging may be associated with delays in treatment without reducing hemorrhage rates or improving clinical outcomes. This exploratory analysis suggests that prospective randomised studies are warranted to support the hypothesis that advanced modality imaging is superior to NCT in improving clinical outcomes.
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影响因子：
3.5
作者：
Tomsick, T.;Broderick, J.;Khoury, J.
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