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E-125 Patient selection for basilar occlusion stroke thrombectomy using conventional versus advanced imaging – an international multicenter investigation
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  1. H Chen1,2,
  2. M Colasurdo3,
  3. H Matsukawa4,
  4. C Cunningham4,
  5. I Maier5,
  6. S Al Kasab4,
  7. P Jabbour6,
  8. J Kim7,
  9. S Wolfe8,
  10. A Rai9,
  11. R Starke10,
  12. M Psychogios11,
  13. E Samaniego12,
  14. N Goyal13,
  15. S Yoshimura14,
  16. H Cuellar15,
  17. J Grossberg16,
  18. A Alawieh16,
  19. A Alaraj17,
  20. M Ezzeldin18,
  21. D Romano19,
  22. O Tanweer20,
  23. J Mascitelli21,
  24. I Fragata22,
  25. A Polifka23,
  26. F Siddiqui24,
  27. J Osbun25,
  28. R Crosa26,
  29. C Matouk27,
  30. M Park28,
  31. M Levitt29,
  32. W Brinjikji30,
  33. M Moss31,
  34. T Dumont32,
  35. E Daglioglu33,
  36. R Williamson34,
  37. P Navia35,
  38. R De Leacy36,
  39. S Chowdhry37,
  40. D Altschul38,
  41. A Spiotta4,
  42. P Kan39
  1. 1National Institute of Neurological Diseases and Stroke, National Institutes of Health, Bethesda MD
  2. 2MedStar Georgetown University Hostpial, Washington, DC
  3. 3Oregon Health and Science University Hospital, Portland, OR
  4. 4Medical University of South Carolina, Charleston, SC
  5. 5Universitätsmedizin Göttingen, University Medicine Goettingen, Göttingen, Germany
  6. 6Thomas Jefferson University, Philadephia, PA
  7. 7Chonnam National University Hospital, Gwangji, Korea, Republic of
  8. 8Wake Forest Baptist Health, Lexington, NC
  9. 9West Virginia University, Morgantown, WV
  10. 10University of Miami Health System, Miami, FL
  11. 11Universitätsspital Basel, Basel, Switzerland
  12. 12University of Iowa, Iowa City, IA
  13. 13University of Tennessee Health Science Center/Semmes Murphey Foundation, Memphis, TN
  14. 14Hyogo College of Medicine, Hyogo, Japan
  15. 15LSU Health Shreveport, Shreveport, LA
  16. 16Emory University, Atlanta, GA
  17. 17University of Chicago at Illinois, Chicago, IL
  18. 18Department of Clinical Sciences, University of Houston, HCA Houston Healthcare Kingwood, Kingwood, TX
  19. 19Aou S. Giovanni di Dio e Ruggi d’Aragona, Salerno, Italy
  20. 20Baylor College of Medicine, Houston, TX
  21. 21University of Texas Health Science Center at San Antonio, San Antonio, TX
  22. 22NOVA Medical School, Universidade Nova de Lisboa, Lisboa, Portugal
  23. 23University of Florida, Gainesville, FL
  24. 24University of Michigan Health West, Wyoming, MI
  25. 25Washington University in St. Louis, St. Louis, MO
  26. 26Médica Uruguaya, Montevideo, Uruguay
  27. 27Yale University, New Haven, CT
  28. 28University of Virginia, Charlottesville, VA
  29. 29University of Washington, Seattle, WA
  30. 30Mayo Clinic in Minnesota, Rochester, MN
  31. 31Washington Regional Medical Center, Fayetteville, AR
  32. 32University of Arizona (Banner), Tucson, AZ
  33. 33Health Science University, Ankara Bilkent City Hospital, Ankara, Turkey
  34. 34Alleghany Hospital, Pittsburgh, PA
  35. 35Hospital Universitario La Paz, Madrid, Spain
  36. 36Mount Sinai Health System, New York, NY
  37. 37NorthShore University Health System, Evanston, IL
  38. 38Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY
  39. 39University of Texas Medical Branch – Galveston, Galveston, TX

Abstract

Background Endovascular thrombectomy (EVT) is an effective treatment for acute ischemic strokes due to basilar artery occlusion; however, treatment benefit is variable and sensitive to radiographic characteristics. While advanced imaging modalities such as computed tomography perfusion (CTP) and magnetic resonance (MR) may be superior in identifying and quantifying infarcted and at-risk tissue, whether conventional imaging (non-contrast CT and CT angiography) is sufficient for patient selection is unclear.

Methods This was an international multi-center retrospective cohort study of the Stroke Thrombectomy and Aneurysm Registry (STAR). Basilar EVT patients treated from 2013 to 2022 were identified. Patient demographics, medical history, and stroke characteristics were captured. Patients selected for treatment by advanced imaging (CTP or MR) were matched with those selected by conventional imaging based on propensity score matching (PSM) of all captured clinical variables. Primary outcome was functional independence at 90 days. Other outcomes include bedridden state or death at 90-days and symptomatic intracranial hemorrhage.

Results 268 patients were identified. 150 patients were selected for basilar EVT by conventional imaging, 86 by CTP, and 32 by MR. Overall, patients selected by advanced imaging were significantly older than those selected by conventional imaging (median age 71 vs. 64 years, p=0.001); patient characteristics were otherwise similar between cohorts. After PSM for possible confounders, 90-day outcomes were similar between the two cohorts (p=0.56), with similar rates of functional independence (39.4% vs. 35.1%, p=0.65), bedridden state or death (40.4% vs. 44.7%, p=0.66), and symptomatic ICH (3.3% vs. 5.7%, p=0.49) for conventional and advanced imaging groups, respectively. Similar results were seen among patient subgroups who underwent EVT within or beyond 6 hours of stroke onset (p>0.05 for all endpoints). Patients selected for treatment by CTP or MR also had similar outcomes compared to their PSM controls (p>0.05 for all endpoints).

Conclusions Selecting patients for basilar EVT using conventional versus advanced imaging did not result in different clinical outcomes. Conventional imaging appears sufficient for selecting basilar EVT patients in routine clinical practice, and the use of advanced imaging modalities may not confer a significant advantage.

Abstract E-125 Figure 1

90-day functional outcomes of propensity-score matched cohorts who were selected for basilar EVT by conventional versus advanced imaging modalities. Statistical comparison conducted using Mann-Whitney U test

Abstract E-125 Table 1

Clinical outcomes of PSM cohorts

Disclosures H. Chen: None. M. Colasurdo: None. H. Matsukawa: None. C. Cunningham: None. I. Maier: None. S. Al Kasab: None. P. Jabbour: None. J. Kim: None. S. Wolfe: None. A. Rai: None. R. Starke: None. M. Psychogios: None. E. Samaniego: None. N. Goyal: None. S. Yoshimura: None. H. Cuellar: None. J. Grossberg: None. A. Alawieh: None. A. Alaraj: None. M. Ezzeldin: None. D. Romano: None. O. Tanweer: None. J. Mascitelli: None. I. Fragata: None. A. Polifka: None. F. Siddiqui: None. J. Osbun: None. R. Crosa: None. C. Matouk: None. M. Park: None. M. Levitt: None. W. Brinjikji: None. M. Moss: None. T. Dumont: None. E. Daglioglu: None. R. Williamson: None. P. Navia: None. R. De Leacy: None. S. Chowdhry: None. D. Altschul: None. A. Spiotta: 2; C; Penumbra, Terumo, RapidAI, Cerenovus. P. Kan: 1; C; Medtronic, Siemens, NIH (1U18EB029353–01). 2; C; Imperative Care, Stryker Neurovascular. 4; C; Vena Medical.

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