Purpose Several randomized controlled trials, have demonstrated improved percentages of independent clinical outcomes with computed tomography (CT)/magnetic resonance (MR) perfusion selection in acute ischemic stroke (AIS), albeit with more stringent patient exclusion. Conversely, preprocedure CT angiography (CTA) is gaining increasing credence among neurointerventionalists for documenting emergent large vessel occlusion and as a surrogate for tissue selection via collateral imaging. In this study, we compared the level and times to recanalization as well as clinical outcomes in patients selected for endovascular thrombectomy based on their perfusion versus single phase CTA imaging selection.

Materials and methods We performed a prospective IRB approved multicenter study of consecutive AIS patients presenting <6 hours from symptom onset that underwent mechanical thrombectomy. Patients were selected after CTA/MRA confirmed ICA/MCA M1-M2 occlusion and either CTP/MRP (favorable mismatch ratio/core infarct volumes) or CT/CTA (ASPECTS >6 and pial collaterals >2/3 MCA) imaging selection. Patient demographics, baseline NIHSS score, THRIVE score, symptom onset to groin puncture times, and the type of thrombectomy devices utilized for recanalization were studied. Modified Rankin Scale score of 0–2 at 90 days defined good functional outcome. Recanalization was delineated by the neurointerventionalist at the end of the thrombectomy according to modified TICI classification. Ordinal recanalization scores of 0, 1, 2, 3, and 4 were assigned to TICI classification of 0, 1, 2a, 2b, and 3, respectively for further evaluation of recanalization reperfusion level. TICI scores of 2 b and 3 defined successful recanalization Chi-square, student t test, Mann-Whitney U, and Kruskal-Wallis tests were utilized for statistical analysis as appropriate.

Results Seventy patients (37 F/33 M, mean age±SD of 64.43 ± 15.08 years) were recruited into the study. Based on preprocedure imaging, consecutive patients were selected for endovascular thrombectomy either by CTA (n = 35) or perfusion studies (n = 35). Both groups were comparable in terms of demographics, NIHSS score, THRIVE score, and thrombectomy devices utilized for recanalization. Symptom onset to groin puncture time was significantly lower in the CTA group (mean = 138.50 min in CTA VS. 224.25 min in perfusion groups, P = 0.012). Recanalization scores were not significantly associated with the type of thrombectomy devices (P = 0.782). Although recanalization scores were significantly higher in patients selected by CTA compared with perfusion imaging (P = 0.020), successful recanalization (TICI 2 b/3) was not significantly different (P = 0.155). There was a nonstatistically significant trend for good functional outcome in CTA group (P = 0.07). Good functional outcome was associated significantly with successful recanalization (P < 0.005).

Conclusions Mechanical thrombectomy patients selected by CTA or perfusion imaging demonstrated no difference in successful recanalization rate, but higher level of recanalization/reperfusion and a trend of improved outcomes with CTA selection that may be attributed to improved treatment times.

Disclosures A. Honarmand: None. A. Shaibani: None. M. Hurley: None. P. Golnari: None. M. Potts: None. B. Jahromi: None. S. Ansari: None.