Comparison between perfusion- And collateral-based triage for endovascular thrombectomy in a late time window

Byungjun Kim, Cheolkyu Jung, Hyo Suk Nam, Byung Moon Kim, Young Dae Kim, Ji Hoe Heo, Dong Joon Kim, Jun Hwee Kim, Kyunghwa Han, Jae Hyoung Kim, Beom Joon Kim

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Abstract

Background and Purpose-Perfusion-based triage has proven to be effective and safe for selecting patients who are likelyto benefit from endovascular thrombectomy (EVT) in a late time window. We investigated collateral-based triage forEVT in patients presenting beyond 6 hours, in terms of interrater reliability and efficacy in predicting clinical outcome,in comparison to perfusion-based triage.Methods-One hundred and thirty-two patients who underwent both computed tomographic angiography and computedtomography perfusion for anterior circulation large artery occlusion 6 to 24 hours after last seen well were enrolled.Patients were classified into EVT-eligible and EVT-ineligible groups according to perfusion- and collateral-based triages.We evaluated the interrater reliability of collateral-based triage and differences in good outcome rates of patients whoreceived EVT in the EVT-eligible groups based on perfusion- and collateral-based triages.Results-Both computed tomographic angiography and computed tomography perfusion were assessable in 93 patients.Seventy-six patients were eligible for EVT according to perfusion-based triage. Among them, EVT was performed in58, of whom 32 (55.1%) had good outcome. Sixty-nine patients were eligible for EVT based on collateral-based triage.Among them, EVT was performed in 50 patients, of whom 31 (62.0%) had good outcome. Interrater reliability ofcollateral-based triage was good (generalized ?=0.73 [95% CI, 0.59-0.84]). Agreement on EVT eligibility betweenperfusion- and collateral-based triages was moderate (?=0.41 [95% CI, 0.16-0.61]). There was no difference in goodoutcome rates of patients who underwent EVT in the EVT-eligible groups based on perfusion- and collateral-basedtriages (55.1% versus 62.0%; P=0.0675).Conclusions-Collateral-based triage showed good interrater reliability and comparable efficacy to that of perfusion-basedtriage in predicting clinical outcome after EVT in patients presenting beyond 6 hours. Collateral-based triage is a reliableapproach for selecting patients for EVT in the extended therapeutic time window.

Original languageEnglish
Pages (from-to)3465-3470
Number of pages6
JournalStroke
Volume50
Issue number12
DOIs
Publication statusPublished - 2019 Dec 1

Keywords

  • Computed tomography angiography
  • Humans
  • Outcome and process assessment (health care)
  • Perfusion
  • Thrombectomy

ASJC Scopus subject areas

  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine
  • Advanced and Specialised Nursing

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    Kim, B., Jung, C., Nam, H. S., Kim, B. M., Kim, Y. D., Heo, J. H., Kim, D. J., Kim, J. H., Han, K., Kim, J. H., & Kim, B. J. (2019). Comparison between perfusion- And collateral-based triage for endovascular thrombectomy in a late time window. Stroke, 50(12), 3465-3470. https://doi.org/10.1161/STROKEAHA.119.027216