Outcomes of Symptomatic Anterior Large Vessel Occlusion by Initial Imaging Assessment Using Diffusion-Weighted Imaging Versus Noncontrast Computed Tomography.

Background: We aimed to compare outcomes after stroke due to anterior circulation large vessel occlusion with initial imaging assessments using diffusion-weighted imaging (DWI) or noncontrast computed tomography (NCCT). Methods: Among 2399 patients with large vessel occlusion stroke in a prospective, multicenter registry, patients with (1) prestroke modified Rankin Scale scores 0 to 1, (2) occlusion of the internal carotid artery or M1 segment of the middle cerebral artery, and (3) onset-to-hospital-arrival time <6 hours were included. The primary effectiveness outcome was good functional outcome, defined as modified Rankin Scale scores 0 to 2 at 3 months. Safety outcomes included symptomatic intracranial hemorrhage. Intergroup biases were accounted for by mixed-effects multivariable modeling and inverse probability of treatment weighting. Results: A total of 343 patients (130 women [37.9%]; median age, 74 years [interquartile range, IQR, 66-82 years]) were analyzed. DWI-based assessment was performed in 217 patients, and NCCT-based assessment was performed in 126 patients. The DWI group showed a lower baseline National Institutes of Health Stroke Scale score ( Conclusions: Potential difference in accuracy of ischemic damage assessment between the 2 modalities did not seem to affect outcomes of anterior circulation large vessel occlusion stroke. Registration: URL: https://www.clinicaltrials.gov; Unique identifier: NCT02419794.