• Mohammed A Almekhlafi, John Thornton, Ilaria Casetta, Mayank Goyal, Stefania Nannoni, Darragh Herlihy, Enrico Fainardi, Sarah Power, Valentina Saia, Aidan Hegarty, Giovanni Pracucci, Andrew Demchuk, Salvatore Mangiafico, Karl Boyle, Patrik Michel, Fouzi Bala, Rubina Gill, Andrea Kuczynski, Ayolla Ademola, Michael D Hill, Danilo Toni, Sean Murphy, Beom Joon Kim, Bijoy K Menon, and Selection Of Late-window Stroke for Thrombectomy by Imaging Collateral Extent (SOLSTICE) Consortium.
• Departments of Clinical Neurosciences, Radiology, and Community Health Sciences. Hotchkiss Brain Institute and O'Brien Institute for Public Health, Cumming School of Medicine at the University of Calgary, Calgary, Alberta, Canada mohammed.almekhlafi1@ucalgary.ca.
• J. Neurol. Neurosurg. Psychiatr. 2022 May 1; 93 (5): 468-474.

Background And PurposeCollateral assessment using CT angiography is a promising modality for selecting patients for endovascular thrombectomy (EVT) in the late window (6-24 hours). The outcome of these patients compared with those selected using perfusion imaging is not clear.MethodsWe pooled data from seven trials and registries of EVT-treated patients in the late-time window. Patients were classified according to the baseline imaging into collateral imaging alone (collateral cohort) and perfusion plus collateral imaging (perfusion cohort). The primary outcome was the proportion of patients achieving independent 90-day functional outcome (modified Rankin Scale 'mRS' 0-2). We used the propensity score-weighting method to balance important predictors between the cohorts.ResultsIn 608 patients, the median onset/last-known-well to emergency arrival time was 8.8 hours and 53.2% had wake-up strokes. Both cohorts had collateral imaging and 379 (62.3%) had perfusion imaging. Independent functional outcome was achieved in 43.1% overall: 168/379 patients (45.5%) in the perfusion cohort versus 94/214 (43.9%) in the collateral cohort (p=0.71). A logistic regression model adjusting for inverse-probability-weighting showed no difference in 90-day mRS score of 0-2 among the perfusion versus collateral cohorts (adjusted OR 1.05, 95% CI 0.69 to 1.59, p=0.83) or in a favourable shift in 90-day mRS (common adjusted OR 1.01, 95% CI 0.69 to 1.47, p=0.97).ConclusionThis pooled analysis of late window EVT showed comparable functional outcomes in patients selected for EVT using collateral imaging alone compared with patients selected using perfusion and collateral imaging.Prospero Registration NumberCRD42020222003.© Author(s) (or their employer(s)) 2022. No commercial re-use. See rights and permissions. Published by BMJ.

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