Key result
Basic imaging selection is linked to higher 90-day functional independence than advanced imaging in thrombectomy.
Why the study?
Advanced imaging modalities such as MRI and CTP have shown potential in guiding late-window endovascular thrombectomy decisions for acute ischemic stroke due to large vessel occlusion, but conflicting data exist regarding their efficacy and benefits on patient outcomes.
Does patient selection using advanced imaging (CTP or MRI) improve 90-day functional independence compared to basic imaging (NCCT ± CTA) in patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy in the late window?
Meta-Analysis (n=12,547)
Does patient selection using advanced imaging (CTP or MRI) improve 90-day functional independence compared to basic imaging (NCCT ± CTA) in patients with large vessel occlusion ischemic stroke undergoing endovascular thrombectomy in the late window?
In patients with late-window large vessel occlusion stroke undergoing thrombectomy, advanced imaging (CTP or MRI) did not demonstrate robust superiority over basic imaging (NCCT ± CTA) for 90-day functional independence or safety.
Answers are grounded in this paper and cite their sources.
Questions advanced imaging for late-window thrombectomy selection; leaves open need for randomized trials to clarify benefit.
Acute Ischemic stroke due to large vessel occlusion is a major cause of death and disability. Advanced imaging modalities, such as Magnetic Resonance Imaging (MRI) and Computed Tomography Perfusion (CTP), have shown potential in guiding EVT decisions in the late window. Still, conflicting data exists on their efficacy and benefits. This systematic review and meta-analysis aimed to improve stroke therapy by assessing the effects of CTP and MRI on patients' outcomes. Studies evaluating the impact of advanced imaging, whether in comparison with basic imaging (non-contrast computed tomography (NCCT) ± Computed Tomography Angiography (CTA)) or intercomparison between MRI and CTP for patients with large vessel occlusion (LVO) undergoing endovascular thrombectomy, were included. The primary outcome was functional independence at 90 days. Procedural safety, hemorrhagic transformation, and mortality were the secondary outcomes. Eleven studies with 12,547 patients were included. Patients who were selected by basic imaging had higher functional independence than those who had advanced imaging. There was no statistically significant difference between diffusion-weighted imaging (DWI) on MRI and CT perfusion (CTP). The risks of any cerebral hemorrhage and symptomatic bleeding did not significantly differ between advanced and basic imaging for secondary outcomes. Unfortunately, these effects were not robust after sensitivity analysis. The mortality benefit of advanced imaging is still unclear, despite basic imaging showing a slight edge in functional results. To identify which patients may benefit most from advanced imaging and to elucidate their function in stroke care, more research is necessary.
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Almuabdi et al. (2026) conducted a meta-analysis in Acute ischemic stroke due to large vessel occlusion (LVO) in the late window (n=12,547). Advanced imaging (CT Perfusion or MRI) vs. Basic imaging (NCCT ± CTA) was evaluated on Functional independence at 90 days. Basic imaging selection yielded higher 90-day functional independence than advanced imaging (CTP/MRI) in 12,547 LVO stroke patients undergoing thrombectomy, though not robust on sensitivity analysis.
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