Advanced Imaging May Not Be Necessary to Screen Stroke Patients for Mechanical Thrombectomy
Boston – Results of an international study show no significant benefits to using advanced imaging instead of routine imaging procedures when determining whether stroke patients with a large vessel occlusion at the base of their brain should undergo a mechanical thrombectomy. Led by researchers at Boston Medical Center, the data showed patients screened for mechanical thrombectomy eligibility using non-contrast computed tomography (CT) had similar outcomes to the patients who had advanced imaging modalities, such as CT perfusion (CTP) and magnetic resonance imaging (MRI). Published in JAMA Neurology, these findings indicate that the more-widely available non-contrast CT imaging can be used to more quickly screen patients for eligibility to undergo the procedure.
This study was conducted at 15 study sites in five countries across North America and Europe and included data from 1,604 patients who presented with proximal anterior circulation occlusion stroke within six to 24 hours after symptoms started. The data was collected for patients who were treated between January 2014 and December 2020. Mechanical thrombectomy is a minimally-invasive surgical procedure that uses a catheter to remove arterial blood clots.
A total of 534 patients were screened to determine eligibility for mechanical thrombectomy using CT imaging; 752 using CTP; and 318 using MRI. According to the Modified Rankin Scale, which assesses disability after a stroke, patients who were screened for the mechanical thrombectomy using CT imaging had similar functional independence than those screened using CTP imaging. The results also demonstrated no significant differences in 90-day mortality or symptomatic intracranial hemorrhage.
“This study shows promising results for being able to screen a patient who presents with large vessel occlusion in the late six to twenty four hour period after symptoms began more quickly using more widely-available imaging technology,” said corresponding author Thanh Nguyen, MD, the director of Interventional Neurology/ Neuroradiology at Boston Medical Center (BMC).
Most patients selected for intervention in this study had little brain tissue damage visible on CT when they presented for care. Furthermore, patients who arrived directly to a comprehensive stroke center and were screened for mechanical thrombectomy using CT had faster times to treatment compared to those who were selected with more advanced imaging.
According to the Centers for Disease Control and Prevention, stroke is the leading cause of death for Americans. More than 795,000 people in the United States has a stroke each year, and every four minutes, someone dies of stroke.
“Advanced imaging is not available in many primary or comprehensive stroke centers across the world,” added Nguyen, also professor of neurology, neurosurgery and radiology at Boston University School of Medicine. “It’s critical that we get treatment to individuals experiencing stroke as quickly as possible, and this study highlights that the less-costly, more simple and accessible imaging technologies can help us do that.”
This study was funded in part by Medtronic and the Society of Vascular and Interventional Neurology.
About Boston Medical Center
Boston Medical Center (BMC) is a private, not-for-profit, 514-bed, academic medical center that is the primary teaching affiliate of Boston University School of Medicine. It is the largest and busiest provider of trauma and emergency services in New England. BMC offers specialized care for complex health problems and is a leading research institution, receiving more than $166 million in sponsored research funding in fiscal year 2019. It is the 13th largest funding recipient in the U.S. from the National Institutes of Health among independent hospitals. In 1997, BMC founded Boston Medical Center Health Plan, Inc., now one of the top ranked Medicaid MCOs in the country, as a non-profit managed care organization. Boston Medical Center and Boston University School of Medicine are partners in Boston HealthNet – 12 community health centers focused on providing exceptional health care to residents of Boston. For more information, please visit http://www.bmc.org.
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