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

Research output: Contribution to journalArticle

Abstract

Background and Purpose- Perfusion-based triage has proven to be effective and safe for selecting patients who are likely to benefit from endovascular thrombectomy (EVT) in a late time window. We investigated collateral-based triage for EVT 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 computed tomography 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 who received 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 in 58, 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 of collateral-based triage was good (generalized κ=0.73 [95% CI, 0.59-0.84]). Agreement on EVT eligibility between perfusion- and collateral-based triages was moderate (κ=0.41 [95% CI, 0.16-0.61]). There was no difference in good outcome rates of patients who underwent EVT in the EVT-eligible groups based on perfusion- and collateral-based triages (55.1% versus 62.0%; P=0.0675). Conclusions- Collateral-based triage showed good interrater reliability and comparable efficacy to that of perfusion-based triage in predicting clinical outcome after EVT in patients presenting beyond 6 hours. Collateral-based triage is a reliable approach 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

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Thrombectomy
Triage
Perfusion

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

Cite this

Comparison Between Perfusion- and Collateral-Based Triage for Endovascular Thrombectomy in a Late Time Window. / Kim, Byungjun; Jung, Cheolkyu; Nam, Hyo Suk; Kim, Byung Moon; Kim, Young Dae; Heo, Ji Hoe; Kim, Dong Joon; Kim, Jun Hwee; Han, Kyunghwa; Kim, Jae Hyoung; Kim, Beom Joon.

In: Stroke, Vol. 50, No. 12, 01.12.2019, p. 3465-3470.

Research output: Contribution to journalArticle

Kim, B, Jung, C, Nam, HS, Kim, BM, Kim, YD, Heo, JH, Kim, DJ, Kim, JH, Han, K, Kim, JH & Kim, BJ 2019, 'Comparison Between Perfusion- and Collateral-Based Triage for Endovascular Thrombectomy in a Late Time Window', Stroke, vol. 50, no. 12, pp. 3465-3470. https://doi.org/10.1161/STROKEAHA.119.027216
Kim, Byungjun ; Jung, Cheolkyu ; Nam, Hyo Suk ; Kim, Byung Moon ; Kim, Young Dae ; Heo, Ji Hoe ; Kim, Dong Joon ; Kim, Jun Hwee ; Han, Kyunghwa ; Kim, Jae Hyoung ; Kim, Beom Joon. / Comparison Between Perfusion- and Collateral-Based Triage for Endovascular Thrombectomy in a Late Time Window. In: Stroke. 2019 ; Vol. 50, No. 12. pp. 3465-3470.
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abstract = "Background and Purpose- Perfusion-based triage has proven to be effective and safe for selecting patients who are likely to benefit from endovascular thrombectomy (EVT) in a late time window. We investigated collateral-based triage for EVT 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 computed tomography 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 who received 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 in 58, 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 of collateral-based triage was good (generalized κ=0.73 [95{\%} CI, 0.59-0.84]). Agreement on EVT eligibility between perfusion- and collateral-based triages was moderate (κ=0.41 [95{\%} CI, 0.16-0.61]). There was no difference in good outcome rates of patients who underwent EVT in the EVT-eligible groups based on perfusion- and collateral-based triages (55.1{\%} versus 62.0{\%}; P=0.0675). Conclusions- Collateral-based triage showed good interrater reliability and comparable efficacy to that of perfusion-based triage in predicting clinical outcome after EVT in patients presenting beyond 6 hours. Collateral-based triage is a reliable approach for selecting patients for EVT in the extended therapeutic time window.",
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author = "Byungjun Kim and Cheolkyu Jung and Nam, {Hyo Suk} and Kim, {Byung Moon} and Kim, {Young Dae} and Heo, {Ji Hoe} and Kim, {Dong Joon} and Kim, {Jun Hwee} and Kyunghwa Han and Kim, {Jae Hyoung} and Kim, {Beom Joon}",
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AU - Kim, Byungjun

AU - Jung, Cheolkyu

AU - Nam, Hyo Suk

AU - Kim, Byung Moon

AU - Kim, Young Dae

AU - Heo, Ji Hoe

AU - Kim, Dong Joon

AU - Kim, Jun Hwee

AU - Han, Kyunghwa

AU - Kim, Jae Hyoung

AU - Kim, Beom Joon

PY - 2019/12/1

Y1 - 2019/12/1

N2 - Background and Purpose- Perfusion-based triage has proven to be effective and safe for selecting patients who are likely to benefit from endovascular thrombectomy (EVT) in a late time window. We investigated collateral-based triage for EVT 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 computed tomography 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 who received 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 in 58, 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 of collateral-based triage was good (generalized κ=0.73 [95% CI, 0.59-0.84]). Agreement on EVT eligibility between perfusion- and collateral-based triages was moderate (κ=0.41 [95% CI, 0.16-0.61]). There was no difference in good outcome rates of patients who underwent EVT in the EVT-eligible groups based on perfusion- and collateral-based triages (55.1% versus 62.0%; P=0.0675). Conclusions- Collateral-based triage showed good interrater reliability and comparable efficacy to that of perfusion-based triage in predicting clinical outcome after EVT in patients presenting beyond 6 hours. Collateral-based triage is a reliable approach for selecting patients for EVT in the extended therapeutic time window.

AB - Background and Purpose- Perfusion-based triage has proven to be effective and safe for selecting patients who are likely to benefit from endovascular thrombectomy (EVT) in a late time window. We investigated collateral-based triage for EVT 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 computed tomography 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 who received 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 in 58, 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 of collateral-based triage was good (generalized κ=0.73 [95% CI, 0.59-0.84]). Agreement on EVT eligibility between perfusion- and collateral-based triages was moderate (κ=0.41 [95% CI, 0.16-0.61]). There was no difference in good outcome rates of patients who underwent EVT in the EVT-eligible groups based on perfusion- and collateral-based triages (55.1% versus 62.0%; P=0.0675). Conclusions- Collateral-based triage showed good interrater reliability and comparable efficacy to that of perfusion-based triage in predicting clinical outcome after EVT in patients presenting beyond 6 hours. Collateral-based triage is a reliable approach for selecting patients for EVT in the extended therapeutic time window.

KW - computed tomography angiography

KW - humans

KW - outcome and process assessment (health care)

KW - perfusion

KW - thrombectomy

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