Magnetic Resonance Imaging Versus Computed Tomography Angiography Based Selection for Endovascular Therapy in Patients With Acute Ischemic Stroke

Joon Tae Kim, Bang Hoon Cho, Kang Ho Choi, Man Seok Park, Beom Joon Kim, Jong Moo Park, Kyusik Kang, Soo Joo Lee, Jae Guk Kim, Jae Kwan Cha, Dae Hyun Kim, Hyun Wook Nah, Tai Hwan Park, Sang Soon Park, Kyung Bok Lee, Jun Lee, Keun Sik Hong, Yong Jin Cho, Hong Kyun Park, Byung Chul Lee & 15 others Kyung Ho Yu, Mi Sun Oh, Dong Eog Kim, Wi Sun Ryu, Jay Chol Choi, Jee Hyun Kwon, Wook Joo Kim, Dong Ick Shin, Min Ju Yeo, Sung Il Sohn, Jeong Ho Hong, Ji Sung Lee, Juneyoung Lee, Hee Joon Bae, Ki Hyun Cho

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background and Purpose- Randomized trials comparing the use of multimodal magnetic resonance imaging (MRI) to multimodal computed tomography (CT)/ CT angiography (CTA) for selecting candidates for endovascular therapy (EVT) have not been reported. This study aimed to elucidate whether MRI-based selection for EVT is safe and effective within and after a 6-hour time window compared with conventional CTA-based selection. Methods- Data from a prospective, nationwide, multicenter stroke registry were analyzed. Workflow timelines were compared between patients selected for EVT based on MRI (the MRI group) and CTA (the CTA group). Multivariable ordinal and binary logistic regression analyses were performed to explore the relationships between decision imaging for EVT and clinical outcomes, including good and excellent outcomes (modified Rankin Scale scores of 0-2 and 0-1, respectively) at 3-month, modified Rankin Scale score distributions and safety outcomes (symptomatic intracranial hemorrhage [SICH] and mortality). Results- Ultimately, 1265 patients (age, 69±12 yrs; men, 55%) were enrolled in this study. The median National Institutes of Health Stroke Scale score was 15 (11-19). All workflow time metrics were significantly delayed in the MRI group compared with the CTA group. There was no difference in good 3-month outcomes in patients arriving within 6 hours of onset between the MRI and CTA groups (38.1% versus 38.5%), but SICH and mortality rates were lower in the MRI group than the CTA group (3.8% versus 7.7%, P=0.01 for SICH; 15.4% versus 20.9%, P=0.04 for mortality). In the multivariable analysis, decision imaging was not significantly associated with 3-month functional outcomes (all P>0.1) or mortality ( P=0.051); however, the MRI group was less likely to develop SICH than the CTA group ( P=0.01; odds ratio, 0.34 [95% CI, 0.17-0.77]). Conclusions- Our study found MRI-based selection for EVT was not associated with improving functional outcome compared with CT-based selection, but may be better at reducing the risk of SICH, despite the delays in all workflow time metrics.

Original languageEnglish
Pages (from-to)365-372
Number of pages8
JournalStroke
Volume50
Issue number2
DOIs
Publication statusPublished - 2019 Feb 1

Fingerprint

Stroke
Magnetic Resonance Imaging
Intracranial Hemorrhages
Workflow
Therapeutics
Mortality
Tomography
Computed Tomography Angiography
Magnetic Resonance Angiography
National Institutes of Health (U.S.)
Registries
Logistic Models
Odds Ratio
Regression Analysis
Safety

Keywords

  • cerebral infarction
  • computed tomography angiography
  • magnetic resonance imaging
  • stroke
  • thrombectomy
  • time-to-treatment

ASJC Scopus subject areas

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

Cite this

Magnetic Resonance Imaging Versus Computed Tomography Angiography Based Selection for Endovascular Therapy in Patients With Acute Ischemic Stroke. / Kim, Joon Tae; Cho, Bang Hoon; Choi, Kang Ho; Park, Man Seok; Kim, Beom Joon; Park, Jong Moo; Kang, Kyusik; Lee, Soo Joo; Kim, Jae Guk; Cha, Jae Kwan; Kim, Dae Hyun; Nah, Hyun Wook; Park, Tai Hwan; Park, Sang Soon; Lee, Kyung Bok; Lee, Jun; Hong, Keun Sik; Cho, Yong Jin; Park, Hong Kyun; Lee, Byung Chul; Yu, Kyung Ho; Oh, Mi Sun; Kim, Dong Eog; Ryu, Wi Sun; Choi, Jay Chol; Kwon, Jee Hyun; Kim, Wook Joo; Shin, Dong Ick; Yeo, Min Ju; Sohn, Sung Il; Hong, Jeong Ho; Lee, Ji Sung; Lee, Juneyoung; Bae, Hee Joon; Cho, Ki Hyun.

In: Stroke, Vol. 50, No. 2, 01.02.2019, p. 365-372.

Research output: Contribution to journalArticle

Kim, JT, Cho, BH, Choi, KH, Park, MS, Kim, BJ, Park, JM, Kang, K, Lee, SJ, Kim, JG, Cha, JK, Kim, DH, Nah, HW, Park, TH, Park, SS, Lee, KB, Lee, J, Hong, KS, Cho, YJ, Park, HK, Lee, BC, Yu, KH, Oh, MS, Kim, DE, Ryu, WS, Choi, JC, Kwon, JH, Kim, WJ, Shin, DI, Yeo, MJ, Sohn, SI, Hong, JH, Lee, JS, Lee, J, Bae, HJ & Cho, KH 2019, 'Magnetic Resonance Imaging Versus Computed Tomography Angiography Based Selection for Endovascular Therapy in Patients With Acute Ischemic Stroke', Stroke, vol. 50, no. 2, pp. 365-372. https://doi.org/10.1161/STROKEAHA.118.023173
Kim, Joon Tae ; Cho, Bang Hoon ; Choi, Kang Ho ; Park, Man Seok ; Kim, Beom Joon ; Park, Jong Moo ; Kang, Kyusik ; Lee, Soo Joo ; Kim, Jae Guk ; Cha, Jae Kwan ; Kim, Dae Hyun ; Nah, Hyun Wook ; Park, Tai Hwan ; Park, Sang Soon ; Lee, Kyung Bok ; Lee, Jun ; Hong, Keun Sik ; Cho, Yong Jin ; Park, Hong Kyun ; Lee, Byung Chul ; Yu, Kyung Ho ; Oh, Mi Sun ; Kim, Dong Eog ; Ryu, Wi Sun ; Choi, Jay Chol ; Kwon, Jee Hyun ; Kim, Wook Joo ; Shin, Dong Ick ; Yeo, Min Ju ; Sohn, Sung Il ; Hong, Jeong Ho ; Lee, Ji Sung ; Lee, Juneyoung ; Bae, Hee Joon ; Cho, Ki Hyun. / Magnetic Resonance Imaging Versus Computed Tomography Angiography Based Selection for Endovascular Therapy in Patients With Acute Ischemic Stroke. In: Stroke. 2019 ; Vol. 50, No. 2. pp. 365-372.
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abstract = "Background and Purpose- Randomized trials comparing the use of multimodal magnetic resonance imaging (MRI) to multimodal computed tomography (CT)/ CT angiography (CTA) for selecting candidates for endovascular therapy (EVT) have not been reported. This study aimed to elucidate whether MRI-based selection for EVT is safe and effective within and after a 6-hour time window compared with conventional CTA-based selection. Methods- Data from a prospective, nationwide, multicenter stroke registry were analyzed. Workflow timelines were compared between patients selected for EVT based on MRI (the MRI group) and CTA (the CTA group). Multivariable ordinal and binary logistic regression analyses were performed to explore the relationships between decision imaging for EVT and clinical outcomes, including good and excellent outcomes (modified Rankin Scale scores of 0-2 and 0-1, respectively) at 3-month, modified Rankin Scale score distributions and safety outcomes (symptomatic intracranial hemorrhage [SICH] and mortality). Results- Ultimately, 1265 patients (age, 69±12 yrs; men, 55{\%}) were enrolled in this study. The median National Institutes of Health Stroke Scale score was 15 (11-19). All workflow time metrics were significantly delayed in the MRI group compared with the CTA group. There was no difference in good 3-month outcomes in patients arriving within 6 hours of onset between the MRI and CTA groups (38.1{\%} versus 38.5{\%}), but SICH and mortality rates were lower in the MRI group than the CTA group (3.8{\%} versus 7.7{\%}, P=0.01 for SICH; 15.4{\%} versus 20.9{\%}, P=0.04 for mortality). In the multivariable analysis, decision imaging was not significantly associated with 3-month functional outcomes (all P>0.1) or mortality ( P=0.051); however, the MRI group was less likely to develop SICH than the CTA group ( P=0.01; odds ratio, 0.34 [95{\%} CI, 0.17-0.77]). Conclusions- Our study found MRI-based selection for EVT was not associated with improving functional outcome compared with CT-based selection, but may be better at reducing the risk of SICH, despite the delays in all workflow time metrics.",
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author = "Kim, {Joon Tae} and Cho, {Bang Hoon} and Choi, {Kang Ho} and Park, {Man Seok} and Kim, {Beom Joon} and Park, {Jong Moo} and Kyusik Kang and Lee, {Soo Joo} and Kim, {Jae Guk} and Cha, {Jae Kwan} and Kim, {Dae Hyun} and Nah, {Hyun Wook} and Park, {Tai Hwan} and Park, {Sang Soon} and Lee, {Kyung Bok} and Jun Lee and Hong, {Keun Sik} and Cho, {Yong Jin} and Park, {Hong Kyun} and Lee, {Byung Chul} and Yu, {Kyung Ho} and Oh, {Mi Sun} and Kim, {Dong Eog} and Ryu, {Wi Sun} and Choi, {Jay Chol} and Kwon, {Jee Hyun} and Kim, {Wook Joo} and Shin, {Dong Ick} and Yeo, {Min Ju} and Sohn, {Sung Il} and Hong, {Jeong Ho} and Lee, {Ji Sung} and Juneyoung Lee and Bae, {Hee Joon} and Cho, {Ki Hyun}",
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TY - JOUR

T1 - Magnetic Resonance Imaging Versus Computed Tomography Angiography Based Selection for Endovascular Therapy in Patients With Acute Ischemic Stroke

AU - Kim, Joon Tae

AU - Cho, Bang Hoon

AU - Choi, Kang Ho

AU - Park, Man Seok

AU - Kim, Beom Joon

AU - Park, Jong Moo

AU - Kang, Kyusik

AU - Lee, Soo Joo

AU - Kim, Jae Guk

AU - Cha, Jae Kwan

AU - Kim, Dae Hyun

AU - Nah, Hyun Wook

AU - Park, Tai Hwan

AU - Park, Sang Soon

AU - Lee, Kyung Bok

AU - Lee, Jun

AU - Hong, Keun Sik

AU - Cho, Yong Jin

AU - Park, Hong Kyun

AU - Lee, Byung Chul

AU - Yu, Kyung Ho

AU - Oh, Mi Sun

AU - Kim, Dong Eog

AU - Ryu, Wi Sun

AU - Choi, Jay Chol

AU - Kwon, Jee Hyun

AU - Kim, Wook Joo

AU - Shin, Dong Ick

AU - Yeo, Min Ju

AU - Sohn, Sung Il

AU - Hong, Jeong Ho

AU - Lee, Ji Sung

AU - Lee, Juneyoung

AU - Bae, Hee Joon

AU - Cho, Ki Hyun

PY - 2019/2/1

Y1 - 2019/2/1

N2 - Background and Purpose- Randomized trials comparing the use of multimodal magnetic resonance imaging (MRI) to multimodal computed tomography (CT)/ CT angiography (CTA) for selecting candidates for endovascular therapy (EVT) have not been reported. This study aimed to elucidate whether MRI-based selection for EVT is safe and effective within and after a 6-hour time window compared with conventional CTA-based selection. Methods- Data from a prospective, nationwide, multicenter stroke registry were analyzed. Workflow timelines were compared between patients selected for EVT based on MRI (the MRI group) and CTA (the CTA group). Multivariable ordinal and binary logistic regression analyses were performed to explore the relationships between decision imaging for EVT and clinical outcomes, including good and excellent outcomes (modified Rankin Scale scores of 0-2 and 0-1, respectively) at 3-month, modified Rankin Scale score distributions and safety outcomes (symptomatic intracranial hemorrhage [SICH] and mortality). Results- Ultimately, 1265 patients (age, 69±12 yrs; men, 55%) were enrolled in this study. The median National Institutes of Health Stroke Scale score was 15 (11-19). All workflow time metrics were significantly delayed in the MRI group compared with the CTA group. There was no difference in good 3-month outcomes in patients arriving within 6 hours of onset between the MRI and CTA groups (38.1% versus 38.5%), but SICH and mortality rates were lower in the MRI group than the CTA group (3.8% versus 7.7%, P=0.01 for SICH; 15.4% versus 20.9%, P=0.04 for mortality). In the multivariable analysis, decision imaging was not significantly associated with 3-month functional outcomes (all P>0.1) or mortality ( P=0.051); however, the MRI group was less likely to develop SICH than the CTA group ( P=0.01; odds ratio, 0.34 [95% CI, 0.17-0.77]). Conclusions- Our study found MRI-based selection for EVT was not associated with improving functional outcome compared with CT-based selection, but may be better at reducing the risk of SICH, despite the delays in all workflow time metrics.

AB - Background and Purpose- Randomized trials comparing the use of multimodal magnetic resonance imaging (MRI) to multimodal computed tomography (CT)/ CT angiography (CTA) for selecting candidates for endovascular therapy (EVT) have not been reported. This study aimed to elucidate whether MRI-based selection for EVT is safe and effective within and after a 6-hour time window compared with conventional CTA-based selection. Methods- Data from a prospective, nationwide, multicenter stroke registry were analyzed. Workflow timelines were compared between patients selected for EVT based on MRI (the MRI group) and CTA (the CTA group). Multivariable ordinal and binary logistic regression analyses were performed to explore the relationships between decision imaging for EVT and clinical outcomes, including good and excellent outcomes (modified Rankin Scale scores of 0-2 and 0-1, respectively) at 3-month, modified Rankin Scale score distributions and safety outcomes (symptomatic intracranial hemorrhage [SICH] and mortality). Results- Ultimately, 1265 patients (age, 69±12 yrs; men, 55%) were enrolled in this study. The median National Institutes of Health Stroke Scale score was 15 (11-19). All workflow time metrics were significantly delayed in the MRI group compared with the CTA group. There was no difference in good 3-month outcomes in patients arriving within 6 hours of onset between the MRI and CTA groups (38.1% versus 38.5%), but SICH and mortality rates were lower in the MRI group than the CTA group (3.8% versus 7.7%, P=0.01 for SICH; 15.4% versus 20.9%, P=0.04 for mortality). In the multivariable analysis, decision imaging was not significantly associated with 3-month functional outcomes (all P>0.1) or mortality ( P=0.051); however, the MRI group was less likely to develop SICH than the CTA group ( P=0.01; odds ratio, 0.34 [95% CI, 0.17-0.77]). Conclusions- Our study found MRI-based selection for EVT was not associated with improving functional outcome compared with CT-based selection, but may be better at reducing the risk of SICH, despite the delays in all workflow time metrics.

KW - cerebral infarction

KW - computed tomography angiography

KW - magnetic resonance imaging

KW - stroke

KW - thrombectomy

KW - time-to-treatment

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