Thrombectomy Outcomes for Anterior Circulation Stroke in the 6–24 h Time Window Solely Based On NCCT and CTA: A Single Center Study

Abstract Purpose Since perfusion imaging may be unavailable in smaller hospitals, alternative imaging selection methods for acute ischemic stroke can improve outcomes and optimize resources. This study assessed the safety and effectiveness of using imaging criteria other than DEFUSE 3 and DAWN for thrombectomy beyond 6 h from symptom onset in patients stroke in the anterior circulation. Methods This is a retrospective, single-center analysis of consecutive patients with large vessel occlusion in the anterior circulation undergoing thrombectomy. Patients were categorized into two groups based on the collateral status (moderate collaterals and good collaterals). Results Among 198 patients, 106 (54%) met the inclusion criteria and were analyzed. Good collateral status was observed in 78 (74%) patients. Patients with good collaterals showed significantly lower mRS scores at discharge and at 90 days compared to their counterparts with moderate collateral status (4 (3–4) vs. 4 (4–5); p = 0.001 and 2 (0–4) vs. 6 (3–6); p < 0.001, respectively). More patients with good collateral status achieved favorable outcomes at 90 days compared to those with moderate status (48 (61.5%) vs. 5 (17.9%); p < 0.001). Good collaterals were an independent predictor of good clinical outcomes at 90 days (OR = 1.31, 95% CI: 1.13–1.53, p < 0.001). Conclusion Selecting patients for endovascular treatment of acute ischemic stroke using non-contrast CT and CT angiography shows 90-day outcomes similar to the DAWN and DEFUSE-3 trials. Using collateral status on CT angiography can predict favorable outcomes after mechanical thrombectomy in resource-limited settings where perfusion imaging is unavailable.