Use of Imaging to Select Patients for Late Window Endovascular Therapy

Gregory W. Albers, MD


Stroke. 2018;49(9):2256-2260. 

In This Article

MRI Versus CTP for Thrombectomy Selection

Among the modern randomized thrombectomy trials that used advanced imaging for patient selection, both of the late window trials[1,2] and one early window study (SWIFT PRIME) allowed the sites to use either CTP or MRI to select patients.[17] The majority of the patients in these studies were included after CTP. Patients who were enrolled with MRI had similar hospital arrival to femoral puncture times, compared with the CTP selected patients, in all 3 trials. Overall, the MRI-selected patients had a slightly higher rate of favorable outcomes and treatment benefit (Table 2). Despite the small sample size in the MRI subgroups, the primary end point of the studies was statistically significant in both MRI- and CTP-selected patients in both SWIFT PRIME and DEFUSE 3. The treatment effect data has not been published for the MRI versus CTP subgroups in DAWN.