Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data

Abstract

Campbell, B. C.V. et al. (2019) Penumbral imaging and functional outcome in patients with anterior circulation ischaemic stroke treated with endovascular thrombectomy versus medical therapy: a meta-analysis of individual patient-level data.ABSTRACT Background: CT-perfusion (CTP) and MRI may assist patient selection for endovascular thrombectomy. We aimed to establish whether imaging assessments of ischaemic core and penumbra volumes were associated with functional outcomes and treatment effect.

Optimizing Patient Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT): A Prospective, Multicenter Cohort Study of Imaging Selection

“…In a recent HERMES (Highly Effective Reperfusion evaluated in Multiple Endovascular Stroke Trials) meta‐analysis assessing functional and safety outcomes based on baseline CT and MRI assessment, a significant improvement in functional outcomes was shown in patients with ASPECTS 3 to 5; however, an increase in symptomatic ICH was also found . Another HERMES meta‐analysis demonstrated improvement in outcomes with thrombectomy in patients with an ischemic core volume > 70ml . However, there were imbalances in baseline characteristics that could not be adjusted for due to the limited sample size.…”

“…25 Another HERMES meta-analysis demonstrated improvement in outcomes with thrombectomy in patients with an ischemic core volume > 70ml. 26 However, there were imbalances in baseline characteristics that could not be adjusted for due to the limited sample size. Therefore, randomized data from large core patients are also necessary to clarify the benefit and risks of EVT.…”

Advances in stroke medicine

“…Brain imaging is key to stroke diagnosis but also provides important prognostic information regarding the extent of irreversible injury and tissue at risk. Individual patient data meta‐analyses of centrally reviewed imaging data from all the endovascular thrombectomy trials have examined the effect of non‐contrast CT hypodensity, collateral blood flow quality, CT perfusion and MRI parameters on prognosis and benefit from endovascular thrombectomy versus medical therapy. Even patients with extensive injury on pre‐treatment imaging can still benefit from thrombectomy.…”

Die Schlaganfallrehabilitation der Zukunft voranbringen: Was sind die nächsten Schritte?

“…Thrombolyse und Thrombektomie Derzeit besteht kein Zweifel daran, dass die Thrombolyse (rTPA) [26] und die mechanische endovaskuläre Thrombektomie (IAT) [9,24] in den ersten Stunden nach dem Schlaganfall die einzigen kurativen und auch die wirksamsten Therapien sind, die wir im Frühphasenmanagement haben. Beide Therapien basieren auf der biologischen Regel, dass der Stoffwechsel von Neuronen und ihre Netzwerke nicht in der Lage sind, mit der Störung des sauerstoffhaltigen regionalen zerebralen Blutflusses nach einem Schlaganfall fertig zu werden.…”