Simple, Advanced CT together best at predicting endovascular thrombectomy results: SELECT Trial

USA: Stroke is the leading cause of long-term disability and the fourth-leading cause of death in the world. Out of two major causes of stroke ischemic stroke more common in which endovascular thrombectomy may be performed to remove a clot lodged in a blood vessel with a mechanical device threaded through an artery. Endovascular thrombectomy is an effective treatment for improving clinical outcomes in stroke up to 24 hours from onset. It is normal to predict which patients will benefit from the procedure.

Researchers at The University of Texas Health Science Center at Houston (UTHealth) have found that both simple and advanced computed tomography (CT) were effective in accurately predicting which stroke patients would benefit from endovascular thrombectomy to remove a large cerebral clot, but together they were even better.

 "Endovascular thrombectomy has revolutionized the treatment for acute stroke patients presenting with large vessel occlusion. Different imaging techniques are used to identify patients who may benefit from this treatment. However, how these imaging profiles correlate with each other and with the stroke outcomes is unknown," said Amrou Sarraj, MD, lead author and associate professor of neurology at McGovern Medical School at UTHealth.

Imaging must be done to determine the location of the clot and whether the patient is a good candidate for thrombectomy, meaning they have a smaller area of brain tissue death. Physicians use non-contrast simple CT and/or CT with an injected contrast dye (CT perfusion) to view the clot and surrounding area of cellular death. While simple CT is readily available at most hospitals, CT perfusion tends to be only available at more advanced stroke centres.

Of the 361 patients enrolled, a significant proportion of patients had favourable imaging results on both the CT and CT perfusion, meaning they were candidates for endovascular thrombectomy. Those patients also had significantly higher odds of receiving endovascular therapy and higher 90-day functional independence rates after recovery (58%).

Even when the two imaging modalities disagreed, the functional and safety outcomes were reasonable (38% achieved functional independence), which was better than the patients who did not receive thrombectomy. Patients with an unfavourable result on CT perfusion imaging, but favourable on simple CT, had higher rates of symptomatic haemorrhage in the brain tissue and death after stroke. Patients with unfavourable imaging profiles on both modalities had very poor outcomes.

"While best outcomes were observed in patients with a favorable profile on both imaging modalities, patients who had a favourable profile on at least one imaging modality also achieved reasonable outcomes," said Sarraj, who sees patients at UT Physicians, the clinical practice of McGovern Medical School, and is an attending neurologist at Memorial Hermann-Texas Medical Center.

The ongoing international Phase III randomized controlled trial, SELECT2, also led by Sarraj, will assess the efficacy and safety of thrombectomy procedure in patients with an unfavorable profile on one or both imaging modalities. The SELECT trials are funded by grants from Stryker Neurovascular. 

For more details click on the link: https://doi.org/10.1002/ana.25669