Evidence map›Paper›PMID 40900221›Full record

ArticleTranslational stroke research2025

How Do Patient Outcomes in Mechanical Thrombectomy for Large-Core Stroke Vary Based on Neuroimaging Modalities Used for Patient Selection? A Multicenter Multinational Study.

Omar Alwakaa, Rahim Abo Kasem, Felipe Ramirez-Velandia, Aryan Wadhwa, Kimberly Han, Michael R Levitt, Ali Alaraj, Pascal Jabbour, Joon-Tae Kim, Brian Howard and 45 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Translational stroke research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. Article
  2. Observational
  3. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

55 authors.

Omar AlwakaaNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA.
Rahim Abo KasemDepartment of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
Felipe Ramirez-VelandiaNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA.
Aryan WadhwaNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA.
Kimberly HanNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA.
Michael R LevittNeurological Surgery, University of Washington School of Medicine, Seattle, WA, USA.
Ali AlarajNeurosurgery, University of Illinois Chicago, Chicago, IL, USA.
Pascal JabbourDepartment of Neurosurgery, Thomas Jefferson University Hospital, Philadelphia, PA, USA.
Joon-Tae KimChonnam National University Medical School, Gwangju, Korea.
Brian HowardDepartment of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
Ali AlawiehDepartment of Neurosurgery, Emory University School of Medicine, Atlanta, GA, USA.
Stacey Quintero WolfeNeurosurgery, Wake Forest School of Medicine, Winston Salem, NC, USA.
Robert M StarkeDepartment of Neurosurgery, University of Miami Miller School of Medicine, Miami, FL, USA.
Marios-Nikos PsychogiosDepartment of Neuroradiology, Clinic of Radiology and Nuclear Medicine, University Hospital Basel, Basel, Switzerland.
Amir ShabanThe University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Nitin GoyalSemmes-Murphey Neurologic and Spine Institute, Memphis, TN, USA.
Justin DyeDepartment of Neurosurgery, Loma Linda University, Loma Linda, CA, USA.
Mohamad EzzeldinDepartment of Clinical Neuroscience, University of Houston, HCA Houston Healthcare Kingwood, Kingwood, TX, USA.
Shinichi YoshimuraDepartment of Neurosurgery, Hyogo College of Medicine, Nishinomiya, Japan.
Daniel SconzoNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA.
Jean FiloNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA.
Samuel PetterssonNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA.
David FiorellaNeurological Surgery, Stony Brook Hospital, Stony Brook, NY, USA.
Omar TanweerDepartment of Neurosurgery, Baylor College of Medicine, Houston, TX, USA.
Daniele G RomanoNeuroradiology, University Hospital 'San Giovanni Di Dio E Ruggi d'Aragona', Salerno, Italy.
Pedro NaviaInterventional and Diagnostic Neuroradiology, Hospital Universitario La Paz, Madrid, Spain.
Hugo CuellarLSUHSC, Shreveport, LA, USA.
Isabel FragataCentro Hospitalar de Lisboa Central, Lisbon, Portugal.
Adam PolifkaDepartment of Neurosurgery, University of Florida, Gainesville, FL, USA.
Justin MascitelliDepartment of Neurosurgery, The University of Texas Health Science Center at San Antonio, San Antonio, TX, USA.
Joshua OsbunWashington University in Saint Louis School of Medicine, Saint Louis, MO, USA.
Fazeel SiddiquiDepartment of Neuroscience, University of Michigan Health-West, Wyoming, MI, USA.
Mark MossWashington Regional Medical Center, Fayetteville, AR, USA.
Kaustubh LimayeDepartment of Neurology, Indiana University, Bloomington, IN, USA.
Maxim MokinDepartment of Neurosurgery, University of South Florida, Tampa, FL, USA.
Charles MatoukYale University, New Haven, CT, USA.
Min S ParkNeurosurgery, University of Virginia, Charlottesville, VA, USA.
Waleed BrinjikjiDepartment of Radiology, Mayo Clinic Minnesota, Rochester, MN, USA.
Ergun DagliogluDepartment of Neurosurgery, Health Science University, Ankara Bilkent City Hospital, Ankara, Turkey.
Richard WilliamsonDepartment of Neurosurgery, Allegheny Health Network, Pittsburgh, PA, USA.
David J AltschulDepartment of Neurosurgery, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA.
Ilko MaierUniversity Medicine Goettingen, Goettingen, Germany.
Roberto CrosaNeurosurgery, Médica Uruguaya, Montevideo, Montevideo, Uruguay.
Benjamin GoryDepartment of Diagnostic and Interventional Neuroradiology, INSERM U947, University Hospital of Nancy, Nancy, France.
Ramesh GrandhiDepartment of Neurosurgery, University of Utah, Salt Lake City, UT, USA.
Alexandra PaulDepartment of Neurosurgery, Albany Medical Center, Albany, NY, USA.
Peter KanDepartment of Neurosurgery, The University of Texas Medical Branch at Galveston, Galveston, TX, USA.
Walter CasagrandeDepartment of Cerebrovascular and Endovascular Neurosurgery, Hospital Juan Fernandez, Buenos Aires, Argentina.
Shakeel ChowdhryNorthShore University HealthSystem, Evanston, IL, USA.
Michael F StiefelDepartment of Neurosurgery, Piedmont Atlanta Hospital, Atlanta, GA, USA.
Ansaar RaiDepartment of Neuroradiology, West Virginia University Hospitals, Morgantown, WV, USA.
Alejandro M SpiottaDepartment of Neurosurgery, Medical University of South Carolina, Charleston, SC, USA.
Philipp TausskyNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA.
Christopher S OgilvyNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA.
Justin H GransteinNeurosurgical Service, Beth Israel Deaconess Medical Center, Harvard Medical School, 110 Francis Street, Boston, MA, 02115, USA. jgranste@bidmc.harvard.edu.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

The role of different imaging modalities-non-contrast CT (NCCT), CT perfusion (CTP), and diffusion-weighted imaging (DWI)-in selecting patients with large-core stroke for endovascular thrombectomy (EVT) is a subject of ongoing debate. This study aims to determine whether patients with large-core acute ischemic stroke (AIS) undergoing EVT triaged with CTP or DWI in addition to NCCT had different clinical outcomes compared to those only triaged with NCCT. We queried the Stroke Thrombectomy and Aneurysm Registry (STAR) for patients enrolled between 2014 and 2023 who presented with anterior-circulation AIS and large ischemic core (ASPECTS < 6) who underwent EVT in 41 stroke centers in the USA, Europe, Asia, and South America. Patients were stratified by the imaging used before EVT. Propensity score matching (PSM) was used to compare balanced cohorts of patients with NCCT vs CTP and NCCT vs DWI. The primary outcome was a favorable 90-day functional status (mRS 0-3). Secondary outcomes included intracerebral hemorrhage (ICH) rates, symptomatic ICH (sICH), and successful/complete recanalization, as determined by mTICI score. A total of 403 patients were included, 121 were selected with NCCT alone, 227 with CTP, and 55 with DWI. Before PSM, 90-day mRS 0-3, successful reperfusion mTICI ≥ 2B, and sICH rates were similar across the three imaging modalities. mTICI-2C or greater rates were highest in DWI (50.9%; p < 0.01), followed by NCCT (41.3%) and CTP (27.8%). Patients selected with CTP had the highest ICH incidence (44.1%; p < 0.01). After 1:1 PSM, 104 pairs of NCCT vs CTP and 36 pairs of NCCT vs DWI were compared. There were no significant differences in any procedural or functional outcome measure between the matched groups, including mTICI ≥ 2C recanalization, 90-day mRS 0-3, ICH rates, and sICH rates. In patients with anterior large-vessel occlusion AIS with low ASPECTS, we found that selecting patients for EVT based on NCCT or employing advanced imaging to elucidate collaterals, infarct volume, and ischemic penumbra does not alter procedural or patient outcomes. NCCT alone may be sufficient to select patients for EVT in this patient population, especially in settings with limited resources.

Indexed as

Ischemic StrokeNeuroimagingPatient SelectionStrokeThrombectomyAgedAged, 80 and overDiffusion Magnetic Resonance ImagingEndovascular ProceduresFemaleHumansMaleMiddle AgedRegistriesTomography, X-Ray ComputedTreatment OutcomeAlberta Stroke Program Early Computed Tomography (ASPECT) scoreEndovascular thrombectomyLarge-vessel occlusionPropensity score matchingStrokeSuccessful recanalization

Identifiers

PMID40900221

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