Clinical Neurology and Neurosurgery 198 (2020) 106207 Available online 7 September 2020 0303-8467/© 2020 Elsevier B.V. All rights reserved. May endovascular thrombectomy without CT perfusion improve clinical outcome? Andrea M Alexandre a, *, Alessandro Pedicelli a , Iacopo Valente a , Luca Scarcia a , Francesca Giubbolini a , Francesco D’Argento a , Emilio Lozupone a , Marisa Distefano b , Fabio Pilato b , Cesare Colosimo a, c a Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Radiologia e Neuroradiologia, Dipartimento di diagnostica per immagini, radioterapia oncologica ed ematologia, Roma, Italy b Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Neurologia, Roma, Italy c Universit` a Cattolica del Sacro Cuore, Istituto di Radiologia, Roma, Italy A R T I C L E INFO Keywords: Stroke Endovascular thrombectomy CT perfusion Stroke after 6 hours Innovative biotechnologies ABSTRACT Background: DAWN and DEFUSE-3 trials demonstrated the beneft of endovascular thrombectomy in late- presenting acute ischemic strokes due to anterior circulation large vessel occlusion. The aim of our study is to evaluate results of endovascular thrombectomy in large intracranial vessel occlusion without perfusion CT pa- tient selection. Methods: we reviewed our prospectively collected endovascular databases for patients with an acute stroke from March 2016 to October 2018, treated after 6 h from stroke onset, without perfusion CT selection. Baseline characteristics, procedural data, and outcomes were evaluated. A good outcome was defned as a 90-day modifed Rankin Scale score of 0–2. The association between clinical and procedural parameters and func- tional outcome was assessed. Results: out of 212 patients 55 were treated after 6 h from stroke onset, 49 of which for an anterior circulation occlusion. 18/49 were functional independent at 90 days (mRS 0–2), Successful recanalization (mTICI 2b to 3) was achieved in 38/49 patients (77 %). Multivariate logistic regression indicated that a low baseline NIHSS was associated with favorable outcome (OR 0.66, 95 % CI 0.520.83, p-value 0.001). Conclusions: in our retrospective analysis, baseline NIHSS is the only parameter that can predict good outcome (90-days mRS 0–2). We confrm data from recent papers assessing that perfusion CT can provide a better pa- tients’ selection compared to mCTA for large vessels occlusion treated beyond six hours from symptom onset. 1. Introduction The importance of endovascular thrombectomy performed even beyond 6 h after the ischemic stroke onset has recently been shown by two randomized controlled trial [1,2] and further validated by other studies [3,3–7]. In DAWN and DEFUSE-3 trials, patient selection was based on infarct volume imaging quantifed by the automated software RAPID (iSchemaView), with two different techniques: perfusion computed tomography (CT) or diffusion-weighted magnetic resonance (DWI MR). DWI-Alberta Stroke Program Early CT Score (ASPECTS) is consid- ered superior to non-contrast CT images [8] and has been used to confrm a brain infarction volume and to estimate the possible mismatch. According to the ISO-SPREAD guidelines - VIII edition [9], CT perfusion was not routinely used in our hospital in emergency setting. For this reason, we performed this study to evaluate the results of me- chanical thrombectomy performed beyond 6 h from stroke onset in patients with large vessels occlusions, without perfusion CT selection, analyzing predicting factors of favorable outcome. * Corresponding author at: Largo A.Gemelli 8, 00168 Roma, Italy. E-mail addresses: andrea.alexandre@policlinicogemelli.it, andrea.alexandre@libero.it (A.M. Alexandre), alessandro.pedicelli@policlinicogemelli.it (A. Pedicelli), iacopo.valente@policlinicogemelli.it (I. Valente), lucascarcia@icloud.com (L. Scarcia), francesca.giubbolini@gmail.com (F. Giubbolini), francesco.dargento@ policlinicogemelli.it (F. D’Argento), emilio.lozupone@policlinicogemelli.it (E. Lozupone), marisa.distefano@hotmail.it (M. Distefano), fabio.pilato@ policlinicogemelli.it (F. Pilato), cesare.colosimo@policlinicogemelli.it (C. Colosimo). Contents lists available at ScienceDirect Clinical Neurology and Neurosurgery journal homepage: www.elsevier.com/locate/clineuro https://doi.org/10.1016/j.clineuro.2020.106207 Received 22 July 2020; Received in revised form 1 September 2020; Accepted 2 September 2020