Stroke, 2019. 50(2), 365-372, DOI: https://doi.org/10.1161/STROKEAHA.118.023173

Magnetic Resonance Imaging Versus Computed Tomography Angiography Based Selection for Endovascular Therapy in Patients With Acute Ischemic Stroke

Joon-Tae Kim, Bang-Hoon Cho;Kang-Ho Choi;Man-Seok Park;Beom Joon Kim;Jong-Moo Park;Kyusik Kang;Soo Joo Lee;Jae Guk Kim;Jae-Kwan Cha;Dae-Hyun Kim;Hyun-Wook Nah;Tai Hwan Park;Sang-Soon Park;Kyung Bok Lee;Jun Lee;Keun-Sik Hong;Yong-Jin Cho;Hong-Kyun Park;Byung-Chul Lee;Kyung-Ho Yu;Mi Sun Oh;Dong-Eog Kim;Wi-Sun Ryu;Jay Chol Choi;Jee-Hyun Kwon;Wook-Joo Kim;Dong-Ick Shin;Min-Ju Yeo;Sung Il Sohn;Jeong-Ho Hong;Ji Sung Lee;Juneyoung Lee;Hee-Joon Bae;Ki-Hyun Cho

Abstract

Background and Purpose

Randomized trials comparing the use of multimodal magnetic resonance imaging (MRI) to multimodal computed tomography (CT)/ CT angiography (CTA) for selecting candidates for endovascular therapy (EVT) have not been reported. This study aimed to elucidate whether MRI-based selection for EVT is safe and effective within and after a 6-hour time window compared with conventional CTA-based selection.

Methods

Data from a prospective, nationwide, multicenter stroke registry were analyzed. Workflow timelines were compared between patients selected for EVT based on MRI (the MRI group) and CTA (the CTA group). Multivariable ordinal and binary logistic regression analyses were performed to explore the relationships between decision imaging for EVT and clinical outcomes, including good and excellent outcomes (modified Rankin Scale scores of 0–2 and 0–1, respectively) at 3-month, modified Rankin Scale score distributions and safety outcomes (symptomatic intracranial hemorrhage [SICH] and mortality).

Results

Ultimately, 1265 patients (age, 69±12 yrs; men, 55%) were enrolled in this study. The median National Institutes of Health Stroke Scale score was 15 (11–19). All workflow time metrics were significantly delayed in the MRI group compared with the CTA group. There was no difference in good 3-month outcomes in patients arriving within 6 hours of onset between the MRI and CTA groups (38.1% versus 38.5%), but SICH and mortality rates were lower in the MRI group than the CTA group (3.8% versus 7.7%, P=0.01 for SICH; 15.4% versus 20.9%, P=0.04 for mortality). In the multivariable analysis, decision imaging was not significantly associated with 3-month functional outcomes (all P>0.1) or mortality (P=0.051);however, the MRI group was less likely to develop SICH than the CTA group (P=0.01; odds ratio, 0.34 [95% CI, 0.17–0.77]).

Conclusions

Our study found MRI-based selection for EVT was not associated with improving functional outcome compared with CT-based selection, but may be better at reducing the risk of SICH, despite the delays in all workflow time metrics.

• DOI: https://doi.org/10.1161/STROKEAHA.118.023173
• ISBN or ISSN: 0039-2499

• 본 연구는 질병관리본부 연구개발과제연구비를 지원받아 수행되었습니다.
• This research was supported by a fund by Research of Korea Centers for Disease Control and Prevention.