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ORIGINAL RESEARCH article

Front. Neurol.
Sec. Endovascular and Interventional Neurology
Volume 15 - 2024 | doi: 10.3389/fneur.2024.1400524
This article is part of the Research Topic Advances and controversies in ischemic stroke management: from prevention to diagnosis and acute treatment View all 73 articles

Comparison between MRI FLAIR Vascular Hyperintensity-DWI Mismatch and Perfusion Based Triage for Thrombectomy in the Late Time Window

Provisionally accepted
Leilei Luo Leilei Luo 1Guanen Zhou Guanen Zhou 1Fanlei Meng Fanlei Meng 2*Shuling Liu Shuling Liu 3Sifei Wang Sifei Wang 3*Yuchao Dou Yuchao Dou 1Da Lu Da Lu 1Ming Wei Ming Wei 3,4*
  • 1 Department of Neurology, Tianjin Huanhu Hospital, Tianjin, Tianjin, China
  • 2 Second Hospital of Tianjin Medical University, Tianjin, China
  • 3 Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
  • 4 Tianjin University, Tianjin, Tianjin, China

The final, formatted version of the article will be published soon.

    Background: The clinical impact of patient selection using FLAIR vascular hyperintensity (FVH)diffusion-weighted imaging (DWI) mismatch for endovascular thrombectomy (EVT) in patients who have been symptomatic for over 6 h remains unclear. Herein, a retrospective study was conducted to compare the inter-rater reliability and clinical outcomes of patients selected for thrombectomy based on FVH-DWI mismatch with perfusion.Methods: Patients with anterior-circulation large-vessel occlusion selected simultaneously with MRI and perfusion imaging in the late time window from a single-center retrospective study were categorized into EVT-applicable (FVH-DWI mismatch on MRI or perfusion imaging meeting the DEFUSE3 standards) and EVT-inapplicable groups based on MRI and perfusion imaging. The primary outcome was the 90-day functional independence rate. Safety outcomes encompassed symptomatic intracranial hemorrhage and mortality in 90 days. We assessed the consistency of the two profiles and compared the differences in functional independence rates of EVT patients among the EVT-applicable groups determined by MRI and perfusion.Results: A total of 130 patients were enrolled, of which 114 were classified into the EVT-applicable group after triaging using MRI images. In this group, 96 patients underwent EVT, with 53 of them (55.2%) achieving functional independence. A total of 110 patients were divided into EVTapplicable group based on perfusion, among which 92 underwent EVT, with 49 of them (53.2%) achieving functional independence. The consistency of identifying EVT indication was moderate between two groups (κ=0.42, 95% CI, 0.17-0.67). The functional independence rate was comparable between patients in the two EVT-applicable groups based on the two methods (55.2% vs. 53.2%, P=0.789).Conclusion: MRI triaging based on FVH-DWI mismatch showed moderate inter-rater reliability compared with perfusion-based triage and comparable efficacy in predicting clinical outcomes after EVT.

    Keywords: FVH-DWI mismatch1, perfusion2, Endovascular thrombectomy3, Acute ischemic stroke4, Triage5

    Received: 13 Mar 2024; Accepted: 12 Jul 2024.

    Copyright: © 2024 Luo, Zhou, Meng, Liu, Wang, Dou, Lu and Wei. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence:
    Fanlei Meng, Second Hospital of Tianjin Medical University, Tianjin, China
    Sifei Wang, Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China
    Ming Wei, Department of Neurosurgery, Tianjin Huanhu Hospital, Tianjin, China

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