The Role of FLAIR Vascular Hyperintensity and Perfusion Imaging in Selecting Patients for Endovascular Thrombectomy
Introduction
Endovascular thrombectomy (EVT) is an effective treatment option for acute ischemic stroke caused by large vessel occlusions. However, selecting the right patients for EVT is crucial for optimizing clinical outcomes. The use of FLAIR vascular hyperintensity (FVH) and diffusion-weighted imaging (DWI) mismatch for patient selection has been a topic of interest in recent years. The purpose of this retrospective study was to compare the inter-rater reliability and clinical outcomes of patients selected for thrombectomy based on FVH-DWI mismatch with perfusion imaging.
Methods
A total of 130 patients with anterior-circulation large-vessel occlusion were selected simultaneously with MRI and perfusion imaging in the late time window from a single-center retrospective study. The patients were categorized into EVT-applicable (FVH-DWI mismatch on MRI or perfusion imaging meeting the DEFUSE3 standards) and EVT-inapplicable groups based on MRI and perfusion imaging. The primary outcome was the 90-day functional independence rate. Safety outcomes encompassed symptomatic intracranial hemorrhage and mortality in 90 days. The consistency of the two profiles and the differences in functional independence rates of EVT patients among the EVT-applicable groups determined by MRI and perfusion were assessed.
Results
Out of the 130 patients enrolled in the study, 114 were classified into the EVT-applicable group after triaging using MRI images. In this group, 96 patients underwent EVT, with 53 of them (55.2%) achieving functional independence. A total of 110 patients were divided into EVT-applicable groups based on perfusion imaging, among which 92 underwent EVT, with 49 of them (53.2%) achieving functional independence. The consistency of identifying EVT indication was moderate between the two groups (κ=0.42, 95% CI, 0.17-0.67). The functional independence rate was comparable between patients in the two EVT-applicable groups based on the two methods (55.2% vs. 53.2%, P=0.789).
Conclusion
MRI triaging based on FVH-DWI mismatch showed moderate inter-rater reliability compared with perfusion-based triage and comparable efficacy in predicting clinical outcomes after EVT. This study highlights the importance of assessing the reliability and efficacy of different patient selection methods for EVT to optimize clinical outcomes.
Keywords
- FVH-DWI mismatch
- perfusion
- endovascular thrombectomy
- acute ischemic stroke
- triage
Originally Post From https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1400524/abstract
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