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CT- VERSUS MRI-BASED IMAGING FOR INTRAVENOUS THROMBOLYSIS AND MECHANICAL THROMBECTOMY IN ISCHEMIC STROKE
Abstract
Background and Aims
It is unclear whether a particular stroke imaging modality (CT or MRI) offers an advantage for the acute stroke treatment. The aim of this study was to compare procedure times, efficacy and safety of thrombolysis and/or thrombectomy based on CT versus MRI acute stroke imaging.
Methods
Data of stroke patients who received thrombolysis (IVT) and/or mechanical thrombectomy (MT) were extracted from a nationwide, prospective stroke unit registry and categorized according to initial imaging modality (CT versus MRI).
Results
16799 patients with IVT and 2248 with MT were included. MRI-guided patients (n=2599) were younger, had less comorbidities, less severe strokes and higher rates of strokes with unknown onset. In IVT patients, no differences were observed in neurological improvement (NIHSS ≥ 4, adjusted OR 0.91, CI 0.82-1.02), functional outcome by mRS 0-1 (adjusted OR 0.87, CI 0.71-1.05), sICH (adjusted OR 0.82 CI 0.61-1.08) and mortality (adjusted OR 0.88 CI 0.63-1.22) between the CT and MRI group. Patients with MT selected by MRI showed equal rates of neurological improvement (NIHSS ≥ 8, adjusted OR 1.03, CI 0.78-1.37), mRS 0-2 (adjusted OR 0.87, CI 0.65-1.16), sICH (adjusted OR 0.9, CI 0.51-1.69) and mortality (adjusted OR 0.62, CI 0.35-1.09) as compared to CT. MRI-guided patients showed a significant intra-hospital delay of 20 minutes in both the IVT and the MT group.
Conclusions
CT guided and MRI guided patient selection for IVT/MT seems to perform equal in means of safety and functional outcome. Standardized workflows are needed to shorten delays in MRI guided stroke patients.