Original Investigation | Neurology Association of Noncontrast Computed Tomography and Perfusion Modalities With Outcomes in Patients Undergoing Late-Window Stroke Thrombectomy Guilherme B. F. Porto, MD; Ching-Jen Chen, MD; Sami Al Kasab, MD; Muhammed Amir Essibayi, MD; Eyad Almallouhi, MD; Zachary Hubbard, MD; Reda Chalhoub, BS; Ali Alawieh, MD; Ilko Maier, MD; Marios-Nikos Psychogios, MD; Stacey Q. Wolfe, MD; Pascal Jabbour, MD; Ansaar Rai, MD; Robert M. Starke, MD, MSc; Amir Shaban, MD; Adam Arthur, MD, MPH; Joon-Tae Kim, MD, PhD; Shinichi Yoshimura, MD, PhD; Jonathan Grossberg, MD; Peter Kan, MD, MPH; Isabel Fragata, MD, PhD; Adam Polifka, MD; Joshua Osbun, MD; Justin Mascitelli, MD; Michael R. Levitt, MD; Richard Williamson Jr, MD; Daniele G. Romano, MD; Roberto Crosa, MD; Benjamin Gory, MD; Maxim Mokin, MD, PhD; Kaustubh S. Limaye, MD; Walter Casagrande, MD; Mark Moss, MD; Ramesh Grandhi, MD; Albert Yoo, MD; Alejandro M. Spiotta, MD; Min S. Park, MD; for the Stroke Thrombectomy and Aneurysm Registry (STAR) Collaborators Abstract IMPORTANCE There is substantial controversy with regards to the adequacy and use of noncontrast head computed tomography (NCCT) for late-window acute ischemic stroke in selecting candidates for mechanical thrombectomy. OBJECTIVE To assess clinical outcomes of patients with acute ischemic stroke presenting in the late window who underwent mechanical thrombectomy stratified by NCCT admission in comparison with selection by CT perfusion (CTP) and diffusion-weighted imaging (DWI). DESIGN, SETTING, AND PARTICIPANTS In this multicenter retrospective cohort study, prospectively maintained Stroke Thrombectomy and Aneurysm (STAR) database was used by selecting patients within the late window of acute ischemic stroke and emergent large vessel occlusion from 2013 to 2021. Patients were selected by NCCT, CTP, and DWI. Admission Alberta Stroke Program Early CT Score (ASPECTS) as well as confounding variables were adjusted. Follow-up duration was 90 days. Data were analyzed from November 2021 to March 2022. EXPOSURES Selection by NCCT, CTP, or DWI. MAIN OUTCOMES AND MEASURES Primary outcome was functional independence (modified Rankin scale 0-2) at 90 days. RESULTS Among 3356 patients, 733 underwent late-window mechanical thrombectomy. The median (IQR) age was 69 (58-80) years, 392 (53.5%) were female, and 449 (65.1%) were White. A total of 419 were selected with NCCT, 280 with CTP, and 34 with DWI. Mean (IQR) admission ASPECTS were comparable among groups (NCCT, 8 [7-9]; CTP, 8 [7-9]; DWI 8, [7-9]; P = .37). There was no difference in the 90-day rate of functional independence (aOR, 1.00; 95% CI, 0.59-1.71; P = .99) after adjusting for confounders. Symptomatic intracerebral hemorrhage (NCCT, 34 [8.6%]; CTP, 37 [13.5%]; DWI, 3 [9.1%]; P = .12) and mortality (NCCT, 78 [27.4%]; CTP, 38 [21.1%]; DWI, 7 [29.2%]; P = .29) were similar among groups. CONCLUSIONS AND RELEVANCE In this cohort study, comparable outcomes were observed in patients in the late window irrespective of neuroimaging selection criteria. Admission NCCT scan may triage emergent large vessel occlusion in the late window. JAMA Network Open. 2022;5(11):e2241291. doi:10.1001/jamanetworkopen.2022.41291 Key Points Question Do patients undergoing late- window stroke thrombectomy achieve similar 90-day outcomes irrespective of image modality selection? Findings This cohort study enrolled 733 patients in the late window undergoing thrombectomy: 419 selected with noncontrast computed tomography (CT); 280, CT perfusion; and 34, diffusion-weighted imaging. After adjustments for confounders, there was no difference in functional independence rates between groups. Meaning These findings suggest late- window stroke thrombectomy patient selection via noncontrast CT is associated with comparable outcomes with perfusion modalities. + Supplemental content Author affiliations and article information are listed at the end of this article. Open Access. This is an open access article distributed under the terms of the CC-BY License. JAMA Network Open. 2022;5(11):e2241291. doi:10.1001/jamanetworkopen.2022.41291 (Reprinted) November 11, 2022 1/11 Downloaded From: https://jamanetwork.com/ on 11/13/2022