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Original research
Non-contrast head CT alone for thrombectomy in acute ischemic stroke: analysis of the ANGEL-ACT registry
  1. Zeguang Ren1,
  2. Gaoting Ma2,
  3. Maxim Mokin1,
  4. Ashutosh P Jadhav3,
  5. Baixue Jia2,
  6. Xu Tong2,
  7. Clayton Bauer1,
  8. Raynald Liu2,
  9. Anxin Wang4,
  10. Xuelei Zhang5,
  11. Dapeng Mo2,
  12. Ning Ma2,
  13. Feng Gao2,
  14. Ligang Song2,
  15. Xuan Sun2,
  16. Xiaochuan Huo2,
  17. Yiming Deng2,
  18. Lian Liu2,
  19. Gang Luo2,
  20. Xiang Luo6,
  21. Ya Peng7,
  22. Liqiang Gui8,
  23. Cunfeng Song9,
  24. Jin Wu10,
  25. Leyuan Wang11,
  26. Chunlei Li12,
  27. Tudor G Jovin13,
  28. Yilong Wang4,14,
  29. Yongjun Wang4,14,
  30. Zhongrong Miao2
  31. on behalf of ANGEL-ACT Study Group
  1. 1Department of Neurosurgery, University of South Florida, Tampa, Florida, USA
  2. 2Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  3. 3Barrow Neurological Institute, Phoenix, Arizona, USA
  4. 4China National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  5. 5Beijing Institute of Brain Disorders, Capital Medical University, Beijing, China
  6. 6Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
  7. 7Neurosurgery, The First People's Hospital of Changzhou,The Third Affiliated Hospital of Soochow University, Changzhou, China
  8. 8Interventional Neuroradiology, Langfang Changzheng Hospital, Langfang, Hebei, China
  9. 9Department of Interventional Neuroradiology, The Third People's Hospital of Liaocheng City, Liaocheng, China
  10. 10Neurology, Nanjing Medical University Second Affiliated Hospital, Nanjing, Jiangsu, China
  11. 11Interventional Neuroradiology Center, Changle People’s Hospital, Weifang, China
  12. 12Department of Neurology, The Second People’s Hospital of Dongying City, Dongying, China
  13. 13Cooper Neurologic Institute, Cooper University Hospital, Camden, New Jersey, USA
  14. 14Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
  1. Correspondence to Dr Zhongrong Miao, Department of Interventional Neuroradiology, Beijing Tiantan Hospital, Beijing 100070, China; zhongrongm{at}163.com

Abstract

Backgroud The goal of this study was to determine if the choice of imaging paradigm performed in the emergency department influences the procedural or clinical outcomes after mechanical thrombectomy (MT).

Methods This is a retrospective comparative outcome study which was conducted from the ANGEL-ACT registry. Comparisons were made between baseline characteristics and clinical outcomes of patients with acute ischemic stroke undergoing MT with non-contrast head computed tomography (NCHCT) alone versus patients undergoing NCHCT plus non-invasive vessel imaging (NVI) (including CT angiography (with or without CT perfusion) and magnetic resonance angiography). The primary outcome was the modified Rankin Scale (mRS) score at 90 days. Secondary outcomes included change in mRS score from baseline to 90 days, the proportions of mRS 0–1, 0–2, and 0–3, and dramatic clinical improvement at 24 hours. The safety outcomes were any intracranial hemorrhage (ICH), symptomatic ICH, and mortality within 90 days.

Results A total of 894 patients met the inclusion criteria; 476 (53%) underwent NCHCT alone and 418 (47%) underwent NCHCT + NVI. In the NCHCT alone group, the door-to-reperfusion time was shorter by 47 min compared with the NCHCT + NVI group (219 vs 266 min, P<0.001). Patients in the NCHCT alone group showed a smaller increase in baseline mRS score at 90 days (median 3 vs 2 points; P=0.004) after adjustment. There were no significant differences between groups in the remaining clinical outcomes.

Conclusions In patients selected for MT using NCHCT alone versus NCHCT + NVI, there were improved procedural outcomes and smaller increases in baseline mRS scores at 90 days.

  • Stroke
  • CT
  • Thrombectomy

Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available to researchers on request for purposes of reproducing the results or replicating the procedure by directly contacting the corresponding author.

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Data availability statement

Data are available upon reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information. All data relevant to the study are included in the article or uploaded as supplementary information. Data are available to researchers on request for purposes of reproducing the results or replicating the procedure by directly contacting the corresponding author.

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Footnotes

  • ZR, GM and MM contributed equally.

  • Collaborators Beijing Tiantan Hospital, Beijing, China: Zhongrong Miao, MD; Langfang Changzheng Hospital, Hebei, China: Liqiang Gui, MD; Liaocheng Third People’s Hospital, Shandong, China: Cunfeng Song, MD; The First People’s Hospital of Changzhou, Jiangsu, China: Ya Peng, MD; The Second Affiliated Hospital of Nanjing Medical University, Jiangsu, China: Jin Wu, MD; Fengrun District People’s Hospital of Tangshan City, Hebei, China: Shijun Zhao, MD; SiPing Central People’s Hospital, Jilin, China: Junfeng Zhao, MD; Yijishan Hospital of Wannan Medical College, Anhui, China: Zhiming Zhou, MD; The 2nd Affiliated Hospital of Harbin Medical University, Heilongjiang, China: Yongli Li, MD; The Central Hospital of Wuhan, Hubei, China: Ping Jing, MD; The First Hospital of Shijiazhuang, Hebei, China: Lei Yang, MD; Shenzhen Hospital of Southern Medical University, Guangdong, China: Yajie Liu, MD; The People’s Hospital of Longhua, Guangdong, China: Qingshi Zhao, MD; Jingjiang People’s Hospital, Jiangsu, China: Yan Liu, MD; The Third People’s Hospital of Hubei Province, Hubei, China: Xiaoxiang Peng, MD; The Second Affiliated Hospital of Guangzhou Medical University, Guangdong, China: Qingchun Gao, MD; Tianjin TEDA Hospital, Tianjin, China: Zaiyu Guo, MD; Zhangzhou Affiliated Hospital of Fujian Medical University, Fujian, China: Wenhuo Chen, MD; Taiyuan Central Hospital, Shanxi, China: Weirong Li, MD; The First Affiliated Hospital of Xinjiang Medical University, Xinjiang, China: Xiaojiang Cheng, MD; Affiliated Drum Tower Hospital of Nanjing University Medical School, Jiangsu, China: Yun Xu, MD; The First People’s Hospital of Wenling, Zhejiang, China: Yongqiang Zhang, MD; The Second Affiliated Hospital of Xi’an Jiaotong University, Shaanxi, China: Guilian Zhang, MD; The First People’s Hospital of Yulin, Guangxi, China: Yijiu Lu, MD; Zhenjiang First People’s Hospital, Jiangsu, China: Xinyu Lu, MD; Qitaihe Coal General Hospital Heilongjiang, China: Dengxiang Wang, MD; People’s Hospital of Tangshan City, Hebei, China: Yan Wang, MD; Affiliated Hospital of Guilin Medical University, Guangxi, China: Hao Li, MD; The Affiliated Hospital of Guizhou Medical University, Guizhou Province, China: Yang Hua, MD; The Affiliated Hospital of Xuzhou Medical University, Jiangsu, China: Deqin Geng, MD; Qingdao Central Hospital, ShanDong, China: Haicheng Yuan, MD; The Fourth People’s Hospital of Langfang City, Hebei, China: Hongwei Wang, MD; Beijing Daxing hospital, Beijing, China: Haihua Yang, MD; Weifang People’s Hospital,ShanDong, China: Zengwu Wang, MD; Luoyang General Hospital Affiliated to Zhengzhou University, Henan, China: Liping Wei, MD; Dongguan Kanghua Hospital, Guangdong, China: Xuancong Liufu, MD; Shunde Hospital of Southern Medical University, Guangdong, China: Xiangqun Shi, MD; Handan Central Hospital, Hebei, China: Juntao Li, MD; The 981 hospital of the Chinese People’s Liberation Army, Hebei, China: Wenwu Yang, MD; Linfen people’s Hospital, Shanxi, China: Wenji Jing, MD; Anshun people’s Hospital of Guizhou, China: Xiang Yong, MD; Changle People’s Hospital, Shandong, China: Leyuan Wang, MD; The Second People’s Hospital of Dongying, Shandong, China: Chunlei Li, MD; Tangshan Gongren hospital, HeBei, China: Yibin Cao, MD; PLA 985th Hospital of the Joint Logistics Support Force, Shanxi, China: Qingfeng Zhu, MD; Gaomi People’s Hospital, ShanDong, China: Peng Zhang, MD; Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Hubei, China: Xiang Luo, MD; Chongqing Sanxia Center Hospital, Chongqing, China: Shengli Chen, MD; Hospital of Traditional Chinese Medicine of Qiannan, Guizhou, China: WenWu Peng, MD; Guangdong Hospital of Chinese Medicine, Guangdong, China: Lixin Wang, MD; People’s hospital of Yangjiang,Guangdong, China: Xue Wen, MD; The Third Affiliated Hospital of CQMU, Chongqing, China: Shugui Shi, MD; General Hospital of The Yangtze River Shipping, Hubei, China: Wanming Wang, MD; First People’s Hospital of Bijie City,Guizhou, China: Wang Bo, MD; Suqian People’s Hospital of Nanjing Drum-Tower Hospital Group, Jiangsu, China: Pu Yuan, MD; Weifang TCM Hospital, Shandong, China: Dong Wang, MD; The Third Affiliated Hospital of Guangzhou Medical University, Guangdong, China: Haitao Guan, MD; Karamay Central hospital, Xinjiang, China: Wenbao Liang, MD; The third people’s Hospital of Xinjiang Uygur Autonomous Region, Xinjiang, China: Daliang Ma, MD; Wulanchabu City Central Hospital, Inner Mongolia, China: Long Chen, MD; Hospital of Xinjiang Production & Construction Corps, Xinjiang, China: Yan Xiao, MD; Jiaozuo Second people’s hospital, Henan, China: Xiangdong Xie, MD; 904th Hospital of Joint Logistic Support Force of PLA, Jiangsu, China: Zhonghua Shi, MD; Ganzhou People’s Hospital, Jiangxi, China: Xiangjun Zeng, MD; 967 Hospital of the Joint Logistics Support Force of PLA, Liaoning, China: Fanfan Su, MD; The Affiliated Hospital of Northwest University Xi’an No.3 Hospital, Shaanxi, China: MingZe Chang, MD; The Second Hospital of Liao Cheng, Shandong, China: Jijun Yin, MD; Jilin Province People’s Hospital, Jilin, China: Hongxia Sun, MD; People’s Hospital of Huanghua City, Hebei, China: Chong Li, MD; Shanghai Forth People’s Hospital, Shanghai, China: Yong Bi, MD; Wanbei Coal-electricity Group Gneral Hospital, Anhui, China: Gang Xie, MD; Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China: Yuwu Zhao, MD; Binzhou Medical University Hospital, Shandong, China: Chao Wang, MD; The 988 hospital of the people’s liberation army, Henan, China: Peng Zhang, MD; Linyi People’s Hospital, Shandong, China: Xianjun Wang, MD; Yingkou City Central Hospital, Liaoning, China: Dongqun Li, MD; Yantaishan Hospital, Shandong, China: Hui Liang, MD; Mianyang Central hospital, Sichuan, China: Zhonglun Chen, MD; Chengdu Fifth People’s Hospital, Sichuan, China: Yan Wang, MD; Hengshui Fifth Hospital of Heng shui City, HeBei, China: Yu Xin, Wang, MD; Second Hospital of Dalian Medical University, Liaoning, China: Lin Yin, MD; Boai Hospital of Zhongshan, Guangdong, China: HongKai Qiu, MD; The First People’s Hospital of Yibin, Sichuan, China: Jun Wei, MD; Shanxi provincial people’s hospital, Shanxi, China: Yaxuan Sun, MD; Shandong Provincial Third Hospital, Cheeloo College of Medicine, Shandong University, Shandong, China: Xiaoya Feng, MD; Chuxiong State People’s Hospital, Chuxiong, Yunnan, China: Weihua Wu, MD; The Fourth Affiliated Hospital of China Medical University, Liaoning, China: Lianbo Gao, MD; Taihe Hospital, Shiyan, Hubei, China: Zhibing Ai, MD; Qingdao Municipal Hospital,Shandong, China: Tan Lan, MD; The First People’s Hospital of Yunnan Province, Yunnan, China: Li Ding, MD; The NO.2 People’s Hospital of Lanzhou. Gansu, China: Qilong Liang, MD; Taizhou First People’s Hospital, Zhejiang, China: Zhimin Wang, MD; Hunan Provincial People’s Hospital, Hunan, China: Jianwen Yang, MD; First People’s Hospital of Changde City, Hunan, China: Ping Xu, MD; Zhejiang Yuyao People’s Hospital, Zhejiang, China: Wei Dong, MD; AideBao Hospital, HeBei, China: Quanle Zheng, MD; The First Hospital of Fangshan District, Beijing, China: Zhenyun Zhu, MD; Tianjin Xiqing Hospital, Tianjin, China: Liyue Zhao, MD; People’s Hospital of Zunhua, Hebei, China: Qingbo Meng, MD; Xingtai Third Hospital, Hebei, China: Yuqing Wei, MD; Qingyuan People’s Hospital, Guangdong, China: Xianglin Chen, MD; Fengcheng City Central Hospital,Liaoning, China: Wei Wang, MD; People’s Hospital of Hejian City, Hebei, China: Dong Sun, MD; Hangzhou Third People’s Hospital, Zhejiang, China: Yongxing Yan, MD; Xiangtan Central Hospital, Hunan, China: Guangxiong Yuan, MD; People’s Hospital of Nanpi Country, Hebei, China: Yadong Yang, MD; Liuzhou Railway Central Hospital, Guangxi, China: Jianfeng Zhou, MD; Maoming People’s Hospital, Guangdong, China: Zhi Yang, MD; Tongde Hospital of Zhejiang Province, Zhejiang, China: Zhenzhong Zhang, MD; The First Affiliated Hospital of Jinzhou Medical University, Liaoning, China: Ning Guan, MD; Xishan coal electricity group worker general hospital, Shaanxi, China: Huihong Wang, MD.

  • Contributors ZM and YW designed and led the study, had full access to all of the data in the study and took responsibility for the integrity of the data and the accuracy of the data analysis. ZR, GM, and MM prepared the first draft of the report. AW did statistical analyses. All authors except MM, APJ, AW, TGJ, YLW, YJW, and ZR participated in patient enrollment and collection of data. All authors critically reviewed the report and approved the final version.

  • Funding Supported by National Key Research and Development Program of China (2016 YFC1301500).

  • Competing interests AW: grants from Young Elite Scientists Sponsorship Program by CAST (2018QNRC001) and Beijing Municipal Administration of Hospitals Incubating Program (PX2020021). DM: grants from National Key Research and Development Program of China (2018YFC1312801). MM: principal investigator of NIH R21NS109575; consultant: Medtronic, Canon Medical, Cerenovus; stock options: Serenity Medical, Synchron, VICIS, Endostream. YJW: research grant from Sanofi, Astra Zeneca and Amgen, contribution to advisory boards from Sanofi. ZM: grants from National Key Research and Development Program of China (2016 YFC1301500). ZR: consultant to Penumbra Company, USA.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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