CT (Computerized Tomography) for Late EndovasculAr Reperfusion

Conditions

Stroke, Cardiovascular

Keywords

Large vessel occlusion, CT [Computed Tomography], CTP [Computed Tomography (CT) Perfusion], Modified Rankin score, ASPECTS (Alberta Stroke Program Early CT Score)

Brief summary

The objective of this multicenter, retrospective, cross-sectional, chart review study is to compare outcomes (disability, complications and mortality) of patients with large vessel occlusion stroke presenting at late time window selected by either Non-Contrast CT (NCCT) only, advanced imaging with CTP (Computed Tomography Perfusion), MRI (Magnetic Resonance Imaging), or medical management. Boston Medical Center (BMC) will serve as the main data coordinating site. Fifteen additional sites will seek local IRB approval or ethics approval. The aggregated de-identified data will be analyzed comparing types of interventions and outcomes by type of imaging or medical management.

Detailed description

Additional subgroup analysis that are planned include: 1. Futile Reperfusion in the Extended Window. We will evaluate clinical, imaging and time metric factors associated with successful reperfusion yet poor outcomes (modified Rankin 3-6) in the 6-24 hour window. An evaluation of factors associated with symptomatic intracranial hemorrhage and mortality will be conducted. 2. Pre-Stroke disability. 1. EVT patients treated in the extended window compared to Medical Management 2. EVT patients treated in the extended window with pre-existing disability vs. those without pre-existing disability 3. Intravenous Thrombolysis in the Extended Window We aim to compare the safety and outcomes of bridging IVT in patients with acute ischemic stroke due to large vessel occlusion (LVO) who underwent EVT 6 to 24 hours after time-last-known-well. 4. Medical Management vs CT selected Patients We hypothesize that in patients with large vessel occlusion in the anterior circulation presenting in the 6 to 24 hour window, patients who are selected by non-contrast CT and treated with endovascular therapy have more favorable outcomes (ordinal mRS shift) as compared to patients who are medically managed. 5. Sex differences in the Extended Window In this study we aim to asses whether there are sex differences in clinical outcomes and safety of EVT in patients presenting in the 6-24 hour time window. 6. Transfer Analysis It is not well established whether transfer patients presenting in the extended window should have repeat imaging upon receipt at the endovascular center after an interim time window. We hypothesize that within a 0 to 2, or 2 to 4 hour delay between images of the primary stroke center to receiving endovascular center, transferred patients in the extended window, who undergo thrombectomy with successful reperfusion will have similar outcomes in patients with or without repeat imaging at the receiving center. We aim to compare the safety and outcomes of late-window bridging IVT vs. direct EVT for LVO acute ischemic stroke in the 6-24 hour time window.

Tomppo L, Martinez-Majander N, Qureshi MM, Nguyen TN, Nogueira RG, Nagel S, Demeestere J, Puetz V, Henon H, Olive-Gadea M, Marto JP, Dusart A, Ringleb PA, Zaidat OO, Haussen DC, Mohammaden MH, Abdalkader M, Raymond J, Ortega-Gutierrez S, Sheth SA, Yamagami H, Ramos JN, Caparros F, Kaiser DPO, Ribo M, Salazar-Marioni S, Tanaka K, Virtanen P, Puri AS, Siegler JE, Zaidi SF, Jumaa M, Lin E, Mayol J, Ventura R, Winzer S, Klein P, Bellante F, Cespedes J, Wouters A, Masoud HE, Shu L, Castonguay AC, Herweh C, Cheng M, Hu W, Roy D, Yaghi S, Lemmens R, Cordonnier C, Möhlenbruch MA, Strbian D.

2025-11-12

10.1161/strokeaha.125.052355

Endovascular Therapy for Late-Window M2-Segment Middle Cerebral Artery Occlusion: Analysis of the CLEAR Study

Simon Winzer, Daniel Kaiser, Muhammad M. Qureshi, Alicia C. Castonguay, Daniel Strbian et al. (61 authors)

Stroke2025-05-234 citations

10.1161/strokeaha.124.048840

Endovascular Therapy for Patients With Low NIHSS Scores and Large Vessel Occlusion in the 6- to 24-Hour Window

João Pedro Marto, Muhammad M. Qureshi, Simon Nagel, Raul G. Nogueira, Hilde Hénon et al. (56 authors)

Neurology2025-03-205 citations

10.1212/wnl.0000000000213442

CLEAR Thrombectomy Score: An Index to Estimate the Probability of Good Functional Outcome With or Without Endovascular Treatment in the Late Window for Anterior Circulation Occlusion

James E. Siegler, Manisha Koneru, Muhammad M. Qureshi, Mohamed Doheim, Raul G. Nogueira et al. (60 authors)

Journal of the American Heart Association2024-07-0913 citations

10.1161/jaha.124.034948

Safety and clinical outcomes of endovascular therapy versus medical management in late presentation of large ischemic stroke

Adnan Mujanović, Daniel Strbian, Jelle Demeestere, João Pedro Marto, Volker Puetz et al. (60 authors)

European Stroke Journal2024-05-1715 citations

10.1177/23969873241249406

Outcomes of Bridging Intravenous Thrombolysis Versus Endovascular Therapy Alone in Late-Window Acute Ischemic Stroke

Jelle Demeestere, Muhammad M. Qureshi, Lieselotte Vandewalle, Anke Wouters, Daniel Strbian et al. (61 authors)

Stroke2024-05-1512 citations

10.1161/strokeaha.124.046495

Noncontrast CT Selected Thrombectomy vs Medical Management for Late-Window Anterior Large Vessel Occlusion.

Nguyen TN, Nogueira RG, Qureshi MM, Nagel S, Raymond J, Abdalkader M, Demeestere J, Marto JP, Sheth SA, Puetz V, Dusart A, Michel P, Ribo M, Zaidat OO, Siegler JE, Haussen DC, Strbian D, Henon H, Mohammaden MH, Möhlenbruch MA, Olive-Gadea M, Puri AS, Winzer S, Kaesmacher J, Klein P, Tomppo L, Caparros F, Ramos JN, Jumaa MA, Zaidi SF, Martinez-Majander N, Nannoni S, Vandewalle L, Bellante F, Farooqui M, Salazar-Marioni S, Virtanen P, Kaiser DPO, Wouters A, Ventura R, Jesser J, Mujanovic A, Shu L, Castonguay AC, Mansoor Z, Qiu Z, Masoud HE, Requena M, Peltola E, Hu W, Lin E, Tanaka K, Cordonnier C, Roy D, Yaghi S, Strambo D, Yamagami H, Fischer U, Jovin TG, Lemmens R, Ringleb PA, Ortega-Gutierrez S.

2024-05-0619 citations

10.1212/wnl.0000000000209324

Reperfusion Without Functional Independence in Late Presentation of Stroke With Large Vessel Occlusion

Fatih Şeker, Muhammad M. Qureshi, Markus Möhlenbruch, Raul G. Nogueira, Mohamad Abdalkader et al. (43 authors)

Stroke2022-10-1496 citations

10.1161/strokeaha.122.039476

Abstract TMP67: Predictors Of Unfavourable Events Despite Successful Mechanical Thrombectomy In The Extended Window

Fatih Şeker, Muhammad M. Qureshi, Markus Möhlenbruch, Raul G. Nogueira, Mohamad Abdalkader et al. (42 authors)

Stroke2022-02-012 citations

10.1161/str.53.suppl_1.tmp67

Interventions

None listed

Study design

Observational model

OTHER

Time perspective

RETROSPECTIVE

Eligibility

Sex/Gender

ALL

Age

18 Years to No maximum

Healthy volunteers

No

Inclusion criteria

* Patients presenting 6-24 hours from last known well with large vessel occlusion stroke * ASPECTS score 5 or greater from last known well * January 1, 2014 to May 1, 2022

Exclusion criteria

-Time last seen well to treatment \<6 hours from last known well

Design outcomes

Primary

Measure	Time frame	Description
Change in patients' disability based on a Modified Rankin Scale	baseline, 90 days	The Modified Rankin Score (mRS) is a 6 point disability scale with possible scores ranging from 0 to 5. Lower scores correlate with less disability/dependence.

Secondary

Measure	Time frame	Description
Intracranial hemorrhage incidence	90 days	Number of cases of intracranial hemorrhage divided by appropriate denominator.
Mortality rate	90 days	Number of deaths divided by appropriate denominator.

Countries

Belgium, Canada, Finland, France, Germany, Japan, Portugal, Spain, Switzerland, United States

Outcome results