Noncontrast versus perfusion CT to select endovascular therapy in an extended time window: Systematic review/meta‐analysis

Author:

Bai Xue1ORCID,Zhang Yao2,Sui Yi123ORCID

Affiliation:

1. School of Public Health China Medical University Shenyang China

2. Department of Neurology, Shenyang First People's Hospital Shenyang Medical College Affiliated Brain Hospital Shenyang China

3. Department of Neurology The First Affiliated Hospital of China Medical University Shenyang China

Abstract

AbstractBackground and PurposeThe effect of noncontrast CT (NCCT) on the eligibility for endovascular therapy (EVT) in an extended time window remains to be elucidated. We sought to assess the efficacy and safety of NCCT in comparison with CT perfusion (CTP) in selecting patients with acute ischemic stroke (AIS) for EVT 6‐24 hours after onset.MethodsPubMed, Embase, and Cochrane libraries were searched from inception to August 31, 2022, to identify all studies reporting 90‐day outcomes of EVT in patients with AIS in an extended time window. A meta‐analysis was performed for the pooled risk ratio (RR) with 95% confidence interval (CI) using a random‐effects model. The primary outcome used to assess efficacy was good functional independence, defined as a modified Rankin Scale score of 0‐2 at 90 days. Secondary outcomes included successful reperfusion, symptomatic intracranial hemorrhage (sICH), and mortality at 90 days.ResultsWe included four nonrandomized studies with a total of 2685 patients. The outcomes of good functional independence at 90 days (RR = 0.98; 95% CI: 0.88‐1.07; I2 = 0%; p = .62), successful reperfusion (RR = 0.98; 95% CI: 0.93‐1.03; I2 = 50.5%; p = .11), sICH (RR = 1.11; 95% CI: 0.55‐2.21; I2 = 49.4%; p = .12), or mortality at 90 days (RR = 1.18; 95% CI: 0.99‐1.40; I2 = 0%; p = .42) did not differ significantly between the two groups.ConclusionsThese findings suggest that NCCT is as effective as CTP in selecting patients for EVT in an extended time window.

Publisher

Wiley

Subject

Neurology (clinical),Radiology, Nuclear Medicine and imaging

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