Perfusion vs non-perfusion computed tomography imaging in the late window of emergent large vessel ischemic stroke: A systematic review and meta-analysis

Jose Danilo B Diestro, Abdelsimar T Omar, Yu-qing Zhang, Teruko Kishibe, Alexander Mastrolonardo, Melissa Mary Lannon, Katrina Ignacio, Eduardo Pimenta Ribeiro Pontes Almeida, Anahita Malvea, Ange Diouf, Arjun Vishnu Sharma, Qingwu Yang, Zhongming Qiu, Mohammed A Almekhlafi, Thanh N Nguyen, Atif Zafar, Vitor Mendes Pereira, Julian Spears, Thomas R Marotta, Forough Farrokhyar and Sunjay Sharma

PLOS ONE, 2024, vol. 19, issue 1, 1-16

Abstract: Background: Guidelines recommend the treatment of emergent large vessel ischemic stroke (ELVIS) patients presenting beyond 6 hours of last known well time with endovascular thrombectomy (EVT) based on perfusion computed tomography (CT) neuroimaging. We compared the outcomes (long-term good clinical outcomes, symptomatic intracranial hemorrhage (sICH), and mortality) of ELVIS patients according to the type of CT neuroimaging they underwent. Methods: We searched the following databases: Medline, Embase, CENTRAL, and Scopus from January 1, 2015, to June 14, 2023. We included studies of late-presenting ELVIS patients undergoing EVT that had with data for non-perfusion and perfusion CT neuroimaging. We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Data were pooled using a random effects model. Results: We found 7 observational cohorts. Non-perfusion versus perfusion CT was not statistically significantly different for both long-term clinical (n = 3,224; RR: 0.96; 95% CI 0.86 to 1.06; I2 = 18%) and sICH (n = 3,724; RR: 1.08 95% CI 0.60 to 1.94; I2 = 76%). Perfusion CT had less mortality (n = 3874; RR: 1.22; 95% CI 1.07 to 1.40; I2 = 0%). The certainty of these findings is very low because of limitations in the risk of bias, indirectness, and imprecision domains of the Grading of Recommendations, Assessment, Development and Evaluations. Conclusion: The use of either non-perfusion or perfusion CT neuroimaging may have little to no effect on long-term clinical outcomes and sICH for late-presenting EVT patients. Perfusion CT neuroimaging may be associated with a reduced the risk of mortality. Evidence uncertainty warrants randomized trial data.

Date: 2024
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Persistent link: https://EconPapers.repec.org/RePEc:plo:pone00:0294127

DOI: 10.1371/journal.pone.0294127

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