Imaging Modalities to Determine Eligibility for Stroke Thrombectomy Outcomes

UH’s Cathy Sila, MD, presents DAWN sub-analysis results at International Stroke Conference

 Cathy Sila, MD

UH Clinical Update - February 2018

Patients selected to undergo mechanical thrombectomy for an acute ischemic stroke fare just as well whether their core infarct is imaged via MRI diffusion-weighted imaging or CT perfusion-cerebral blood flow imaging. That’s according to new DAWN study research from Cathy Sila, MD, Director of the Comprehensive Stroke Center at UH Cleveland Medical Center, and colleagues.

Dr. Sila presented the results of the DAWN sub-analysis at the recent International Stroke Conference in Los Angeles. Several UH neurologists and RN stroke specialists attended the conference.

“The infarct core is a powerful predictor of outcome after acute stroke and a major determinant of safety and efficacy of mechanical thrombectomy,” she says. “In an expanded time window for endovascular treatment, outcomes may be more dependent upon an accurate measurement of the core infarct. In DAWN, the core infarct could be measured by MRI diffusion-weighted imaging or CT perfusion- cerebral blood flow imaging. We sought to determine if there was an advantage to patient outcomes if they were selected by one or the other imaging modality.”

Although no significant differences were found between the two imaging modalities, Dr. Sila says more research is still needed.

“No significant differences were seen in one imaging study performing better at identifying patients, but this secondary analysis was underpowered,” she says. “There were some differences in patient outcomes that didn’t rise to the level of statistical significance. If we had a larger population, could these become significant? Ultimately, we want to steer the workflow to the ‘best’ imaging.”

“Now that we have successfully expanded the treatment options for patients with acute, devastating stroke, of course we will try to see where else we can push the envelope and give more patients hope of a successful treatment,” she adds. “Already trials are being discussed that will seek to treat more complex patients, at longer times and with larger core infarcts. My belief is that the choice of imaging modality will become more important, and we need to continue to study this.”