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- Title
Perfusion vs non-perfusion computed tomography imaging in the late window of emergent large vessel ischemic stroke: A systematic review and meta-analysis.
- Authors
Diestro, Jose Danilo B.; Omar II, Abdelsimar T.; Zhang, Yu-qing; Kishibe, Teruko; Mastrolonardo, Alexander; Lannon, Melissa Mary; Ignacio, Katrina; Pimenta Ribeiro Pontes Almeida, Eduardo; Malvea, Anahita; Diouf, Ange; Sharma, Arjun Vishnu; Yang, Qingwu; Qiu, Zhongming; Almekhlafi, Mohammed A.; Nguyen, Thanh N.; Zafar, Atif; Pereira, Vitor Mendes; Spears, Julian; Marotta, Thomas R.; Farrokhyar, Forough
- Abstract
Background: Guidelines recommend the treatment of emergent large vessel ischemic stroke (ELVIS) patients presenting beyond 6 hours of last known well time with endovascular thrombectomy (EVT) based on perfusion computed tomography (CT) neuroimaging. We compared the outcomes (long-term good clinical outcomes, symptomatic intracranial hemorrhage (sICH), and mortality) of ELVIS patients according to the type of CT neuroimaging they underwent. Methods: We searched the following databases: Medline, Embase, CENTRAL, and Scopus from January 1, 2015, to June 14, 2023. We included studies of late-presenting ELVIS patients undergoing EVT that had with data for non-perfusion and perfusion CT neuroimaging. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data were pooled using a random effects model. Results: We found 7 observational cohorts. Non-perfusion versus perfusion CT was not statistically significantly different for both long-term clinical (n = 3,224; RR: 0.96; 95% CI 0.86 to 1.06; I2 = 18%) and sICH (n = 3,724; RR: 1.08 95% CI 0.60 to 1.94; I2 = 76%). Perfusion CT had less mortality (n = 3874; RR: 1.22; 95% CI 1.07 to 1.40; I2 = 0%). The certainty of these findings is very low because of limitations in the risk of bias, indirectness, and imprecision domains of the Grading of Recommendations, Assessment, Development and Evaluations. Conclusion: The use of either non-perfusion or perfusion CT neuroimaging may have little to no effect on long-term clinical outcomes and sICH for late-presenting EVT patients. Perfusion CT neuroimaging may be associated with a reduced the risk of mortality. Evidence uncertainty warrants randomized trial data.
- Subjects
ISCHEMIC stroke; COMPUTED tomography; PERFUSION; ENDOVASCULAR surgery; INTRACRANIAL hemorrhage; RANDOM effects model; NO-tillage
- Publication
PLoS ONE, 2024, Vol 19, Issue 1, p1
- ISSN
1932-6203
- Publication type
Article
- DOI
10.1371/journal.pone.0294127