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Comparison Between Perfusion- and Collateral-Based Triage for Endovascular Thrombectomy in a Late Time Window

Authors
 Byungjun Kim  ;  Cheolkyu Jung  ;  Hyo Suk Nam  ;  Byung Moon Kim  ;  Young Dae Kim  ;  Ji Hoe Heo  ;  Dong Joon Kim  ;  Jun-Hwee Kim  ;  Kyunghwa Han  ;  Jae Hyoung Kim  ;  Beom Joon Kim 
Citation
 STROKE, Vol.50(12) : 3465-3470, 2019 
Journal Title
 STROKE 
ISSN
 0039-2499 
Issue Date
2019
Keywords
computed tomography angiography ; humans ; outcome and process assessment (health care) ; perfusion ; thrombectomy
Abstract
Background and Purpose- Perfusion-based triage has proven to be effective and safe for selecting patients who are likely to benefit from endovascular thrombectomy (EVT) in a late time window. We investigated collateral-based triage for EVT in patients presenting beyond 6 hours, in terms of interrater reliability and efficacy in predicting clinical outcome, in comparison to perfusion-based triage. Methods- One hundred and thirty-two patients who underwent both computed tomographic angiography and computed tomography perfusion for anterior circulation large artery occlusion 6 to 24 hours after last seen well were enrolled. Patients were classified into EVT-eligible and EVT-ineligible groups according to perfusion- and collateral-based triages. We evaluated the interrater reliability of collateral-based triage and differences in good outcome rates of patients who received EVT in the EVT-eligible groups based on perfusion- and collateral-based triages. Results- Both computed tomographic angiography and computed tomography perfusion were assessable in 93 patients. Seventy-six patients were eligible for EVT according to perfusion-based triage. Among them, EVT was performed in 58, of whom 32 (55.1%) had good outcome. Sixty-nine patients were eligible for EVT based on collateral-based triage. Among them, EVT was performed in 50 patients, of whom 31 (62.0%) had good outcome. Interrater reliability of collateral-based triage was good (generalized κ=0.73 [95% CI, 0.59-0.84]). Agreement on EVT eligibility between perfusion- and collateral-based triages was moderate (κ=0.41 [95% CI, 0.16-0.61]). There was no difference in good outcome rates of patients who underwent EVT in the EVT-eligible groups based on perfusion- and collateral-based triages (55.1% versus 62.0%; P=0.0675). Conclusions- Collateral-based triage showed good interrater reliability and comparable efficacy to that of perfusion-based triage in predicting clinical outcome after EVT in patients presenting beyond 6 hours. Collateral-based triage is a reliable approach for selecting patients for EVT in the extended therapeutic time window.
Full Text
https://www.ahajournals.org/doi/full/10.1161/STROKEAHA.119.027216
DOI
10.1161/STROKEAHA.119.027216
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiology (영상의학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurology (신경과학교실) > 1. Journal Papers
5. Research Institutes (연구소) > Others (기타) > 1. Journal Papers
Yonsei Authors
Kim, Dong Joon(김동준) ORCID logo https://orcid.org/0000-0002-7035-087X
Kim, Byung Moon(김병문) ORCID logo https://orcid.org/0000-0001-8593-6841
Kim, Young Dae(김영대) ORCID logo https://orcid.org/0000-0001-5750-2616
Kim, Jun-Hwee(김준휘)
Nam, Hyo Suk(남효석) ORCID logo https://orcid.org/0000-0002-4415-3995
Han, Kyung Hwa(한경화)
Heo, Ji Hoe(허지회) ORCID logo https://orcid.org/0000-0001-9898-3321
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/174656
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