title: Computed Tomographic Perfusion Selection and Clinical Outcomes After Endovascular Therapy in Large Vessel Occlusion Stroke.
abstract: Different imaging paradigms have been used to select patients for endovascular therapy in stroke. We sought to determine whether computed tomographic perfusion (CTP) selection improves endovascular therapy outcomes compared with noncontrast computed tomography alone.
  
  
  
  Review of a prospectively collected registry of anterior circulation stroke patients undergoing stent-retriever thrombectomy at a tertiary care center between September 2010 and March 2016. Patients undergoing CTP were compared with those with noncontrast computed tomography alone. The primary outcome was the shift in the 90-day modified Rankin scale (mRS).
  
  
  
  A total of 602 patients were included. CTP-selected patients (n=365, 61%) were younger (P=0.02) and had fewer comorbidities. CTP selection (n=365, 61%) was associated with a favorable 90-day mRS shift (adjusted odds ratio [aOR]=1.49; 95% confidence interval [CI], 1.06-2.09;P=0.02), higher rates of good outcomes (90-day mRS score 0-2: 52.9% versus 40.4%;P=0.005), modified Thrombolysis in Cerebral Infarction-3 reperfusion (54.8% versus 40.1%;P<0.001), smaller final infarct volumes (24.7 mL [9.8-63.1 mL] versus 34.6 mL [13.1-88 mL];P=0.017), and lower mortality (16.6% versus 26.8%;P=0.005). When matched on age, National Institutes of Health Stroke Scale (NIHSS) score, and glucose (n=424), CTP remained associated with a favorable 90-day mRS shift (P=0.016), lower mortality (P=0.02), and higher rates of reperfusion (P<0.001). CTP better predicted functional outcomes in patients presenting after 6 hours (as assessed by comparison of logistic regression models: Akaike information criterion: 199.35 versus 287.49 and Bayesian information criterion: 196.71 versus 283.27) and those with an Alberta Stroke Program Early Computed Tomography Score ≤7 (Akaike information criterion: 216.69 versus 334.96 and Bayesian information criterion: 213.6 versus 329.94).
  
  
  
  CTP selection is associated with a favorable mRS shift in patients undergoing stent-retriever thrombectomy. Future prospective studies are warranted.
authors.affiliation: From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Bouslama
authors.affiliation: From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA.
authors.forename: Diogo C
authors.initials: DC
authors.lastname: Haussen
authors.affiliation: From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Grossberg
authors.affiliation: From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA.
authors.forename: Seena
authors.initials: S
authors.lastname: Dehkharghani
authors.affiliation: From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA.
authors.forename: Meredith T
authors.initials: MT
authors.lastname: Bowen
authors.affiliation: From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA.
authors.forename: Leticia C
authors.initials: LC
authors.lastname: Rebello
authors.affiliation: From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA.
authors.forename: Nicolas A
authors.initials: NA
authors.lastname: Bianchi
authors.affiliation: From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA.
authors.forename: Michael R
authors.initials: MR
authors.lastname: Frankel
authors.affiliation: From the Department of Neurology, Neurosurgery and Radiology, Grady Memorial Hospital and Emory University School of Medicine, Atlanta, GA. raul.g.nogueira@emory.edu.
authors.forename: Raul G
authors.initials: RG
authors.lastname: Nogueira
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D002539:Cerebral Arterial Diseases / Q000150:complications / Q000000981:diagnostic imaging*; D002560:Cerebrovascular Circulation; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D015607:Stents; D020521:Stroke / Q000000981:diagnostic imaging* / Q000209:etiology; D017131:Thrombectomy / Q000295:instrumentation / Q000379:methods*; D014057:Tomography, X-Ray Computed / Q000379:methods* / Q000592:standards
keywords: brain ischemia; perfusion imaging; reperfusion; stroke; thrombectomy