Simple CT Scans Can Determine Thrombectomy Need

A new study suggests that using non-contrast simple computerized tomography (CT) scans to determine thrombectomy treatment in stroke is just as effective as advanced CT perfusion scans.

Researchers at the University of Texas Health Science Center (UT Health; Houston, TX; USA) and Stanford University (CA, USA) conducted a clinical trial, which enrolled 445 patients who received both simple and advanced imaging at nine academic health centers across the United States from January 2016 to February 2018. The results showed that patients who were treated based on simple imaging had identical clinical outcomes to those treated based on advanced imaging.

In addition, those patients who had a good imaging profile--as demonstrated by a smaller area of dead brain tissue--had the same clinical outcomes, regardless of which imaging was used. On the other hand, 42% of patients who were excluded from thrombectomy by one of the imaging profiles, but had a good profile on the other type of imaging, also had positive clinical outcomes. The study was presented at the 4th European Stroke Organization Conference (ESOC), held during May 2018 in Göteborg (Sweden).

“The results show that simple imaging, while not perfect, may be good enough. This basic technique is faster, which means patients could potentially be treated more quickly,” said lead author Amrou Sarraj, MD, of UT Health. “The advanced imaging of CT perfusion isn't available everywhere, so this could open up the door to identify more people for potential treatment, especially in remote areas.”

“Our results should not be interpreted that advanced perfusion images are not necessary, or should not be acquired at all, as they still identified a group of patients that may be treated with thrombectomy when CT alone was not enough,” cautioned Dr. Sarraj. “The numbers involved are significant because 17.6% of patients could have been excluded from having surgery if the CT or CT perfusion were relied on alone, so there's a real opportunity here to help more people if both forms of imaging are available.”

Timely restoration of cerebral blood flow using reperfusion therapy is the most effective maneuver for salvaging ischemic brain tissue that is not already infarcted. For eligible patients with acute ischemic stroke, intravenous alteplase is first-line therapy, provided that treatment is initiated within 4.5 hours of clearly defined symptom onset. Mechanical thrombectomy is indicated for patients with acute ischemic stroke due to a large artery occlusion in the anterior circulation who can be treated within 24 hours of the time last known to be well, regardless of whether they receive intravenous alteplase for the same ischemic stroke event.

Related Links:
University of Texas Health Science Center
Stanford University