Collateral Circulation in Thrombectomy for Stroke After 6 to 24 Hours in the DAWN Trial

Stroke ◽  
2021 ◽  
Author(s):  
David S. Liebeskind ◽  
Hamidreza Saber ◽  
Bin Xiang ◽  
Ashutosh P. Jadhav ◽  
Tudor G. Jovin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Scale Score ◽  
Collateral Circulation ◽  
Time Window ◽  
Infarct Volume ◽  
Late Time ◽  
Collateral Flow ◽  
Modified Rankin Scale ◽  
Diverse Range ◽  
Wide Range

Background and Purpose: Collaterals govern the pace and severity of cerebral ischemia, distinguishing fast or slow progressors and corresponding therapeutic opportunities. The fate of sustained collateral perfusion or collateral failure is poorly characterized. We evaluated the nature and impact of collaterals on outcomes in the late time window DAWN trial (Diffusion-Weighted Imaging or Computed Tomography Perfusion Assessment With Clinical Mismatch in the Triage of Wake-Up and Late Presenting Strokes Undergoing Neurointervention With Trevo). Methods: The DAWN Imaging Core Lab prospectively scored collateral grade on baseline computed tomography angiography (CTA; endovascular and control arms) and digital subtraction angiography (DSA; endovascular arm only), blinded to all other data. CTA collaterals were graded with the Tan scale and DSA collaterals were scored by ASITN grade (American Society of Interventional and Therapeutic Neuroradiology collateral score). Descriptive statistics characterized CTA collateral grade in all DAWN subjects and DSA collaterals in the endovascular arm. The relationship between collateral grade and day 90 outcomes were separately analyzed for each treatment arm. Results: Collateral circulation to the ischemic territory was evaluated on CTA (n=144; median 2, 0–3) and DSA (n=57; median 2, 1–4) before thrombectomy in 161 DAWN subjects (mean age 69.8±13.6 years; 55.3% women; 91 endovascular therapy, 70 control). CTA revealed a broad range of collaterals (Tan grade 3, n=64 [44%]; 2, n=45 [31%]; 1, n=31 [22%]; 0, n=4 [3%]). DSA also showed a diverse range of collateral grades (ASITN grade 4, n=4; 3, n=22; 2, n=27; 1, n=4). Across treatment arms, baseline demographics, clinical variables except atrial fibrillation (41.6% endovascular versus 25.0% controls, P =0.04), and CTA collateral grades were balanced. Differences were seen across the 3 levels of collateral flow (good, fair, poor) for baseline National Institutes of Health Stroke Scale, blood glucose <150, diabetes, previous ischemic stroke, baseline and 24-hour core infarct volume, baseline and 24-hour Alberta Stroke Program Early CT Score, dramatic infarct progression, final Thrombolysis in Cerebral Infarction 2b+, and death. Collateral flow was a significant predictor of 90-day modified Rankin Scale score of 0 to 2 in the endovascular arm, with 43.7% (31/71) of subjects with good collaterals, 30.8% (16/52) of subjects with fair collaterals, and 17.7% (6/34) of subjects with poor collaterals reaching modified Rankin Scale score of 0 to 2 at 90 days ( P =0.026). Conclusions: DAWN subjects enrolled at 6 to 24 hours after onset with limited infarct cores had a wide range of collateral grades on both CTA and DSA. Even in this late time window, better collaterals lead to slower stroke progression and better functional outcomes. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT02142283.

scholarly journals Mobile Interventional Stroke Teams Improve Outcomes in the Early Time Window for Large Vessel Occlusion Stroke

Stroke ◽  
2021 ◽  
Author(s):  
Jacob R. Morey ◽  
Xiangnan Zhang ◽  
Naoum Fares Marayati ◽  
Stavros Matsoukas ◽  
Emily Fiano ◽  
...  
Keyword(s):  
Scale Score ◽  
Time Window ◽  
Early Time ◽  
National Institutes Of Health ◽  
Large Vessel ◽  
Late Time ◽  
Modified Rankin Scale ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion ◽  
Endovascular Thrombectomy

Background and Purpose: Endovascular thrombectomy for large vessel occlusion stroke is a time-sensitive intervention. The use of a Mobile Interventional Stroke Team (MIST) traveling to Thrombectomy Capable Stroke Centers to perform endovascular thrombectomy has been shown to be significantly faster with improved discharge outcomes, as compared with the drip-and-ship (DS) model. The effect of the MIST model stratified by time of presentation has yet to be studied. We hypothesize that patients who present in the early window (last known well of ≤6 hours) will have better clinical outcomes in the MIST model. Methods: The NYC MIST Trial and a prospectively collected stroke database were assessed for patients undergoing endovascular thrombectomy from January 2017 to February 2020. Patients presenting in early and late time windows were analyzed separately. The primary end point was the proportion with a good outcome (modified Rankin Scale score of 0–2) at 90 days. Secondary end points included discharge National Institutes of Health Stroke Scale and modified Rankin Scale. Results: Among 561 cases, 226 patients fit inclusion criteria and were categorized into MIST and DS cohorts. Exclusion criteria included a baseline modified Rankin Scale score of >2, inpatient status, or fluctuating exams. In the early window, 54% (40/74) had a good 90-day outcome in the MIST model, as compared with 28% (24/86) in the DS model ( P <0.01). In the late window, outcomes were similar (35% versus 41%; P =0.77). The median National Institutes of Health Stroke Scale at discharge was 5.0 and 12.0 in the early window ( P <0.01) and 5.0 and 11.0 in the late window ( P =0.11) in the MIST and DS models, respectively. The early window discharge modified Rankin Scale was significantly better in the MIST model ( P <0.01) and similar in the late window ( P =0.41). Conclusions: The MIST model in the early time window results in better 90-day outcomes compared with the DS model. This may be due to the MIST capturing high-risk fast progressors at an earlier time point. REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique identifier: NCT03048292.

scholarly journals Computed tomography angiography-based deep learning method for treatment selection and infarct volume prediction in anterior cerebral circulation large vessel occlusion

2021 ◽  
Vol 10 (11) ◽  
pp. 205846012110603
Author(s):  
Lasse Hokkinen ◽  
Teemu Mäkelä ◽  
Sauli Savolainen ◽  
Marko Kangasniemi
Keyword(s):  
Neural Network ◽  
Computed Tomography ◽  
Convolutional Neural Network ◽  
Computed Tomography Angiography ◽  
Time Window ◽  
Infarct Volume ◽  
Correlation Coefficients ◽  
Late Time ◽  
Large Vessel Occlusion ◽  
Vessel Occlusion

Background Computed tomography perfusion (CTP) is the mainstay to determine possible eligibility for endovascular thrombectomy (EVT), but there is still a need for alternative methods in patient triage. Purpose To study the ability of a computed tomography angiography (CTA)-based convolutional neural network (CNN) method in predicting final infarct volume in patients with large vessel occlusion successfully treated with endovascular therapy. Materials and Methods The accuracy of the CTA source image-based CNN in final infarct volume prediction was evaluated against follow-up CT or MR imaging in 89 patients with anterior circulation ischemic stroke successfully treated with EVT as defined by Thrombolysis in Cerebral Infarction category 2b or 3 using Pearson correlation coefficients and intraclass correlation coefficients. Convolutional neural network performance was also compared to a commercially available CTP-based software (RAPID, iSchemaView). Results A correlation with final infarct volumes was found for both CNN and CTP-RAPID in patients presenting 6–24 h from symptom onset or last known well, with r = 0.67 ( p < 0.001) and r = 0.82 ( p < 0.001), respectively. Correlations with final infarct volumes in the early time window (0–6 h) were r = 0.43 ( p = 0.002) for the CNN and r = 0.58 ( p < 0.001) for CTP-RAPID. Compared to CTP-RAPID predictions, CNN estimated eligibility for thrombectomy according to ischemic core size in the late time window with a sensitivity of 0.38 and specificity of 0.89. Conclusion A CTA-based CNN method had moderate correlation with final infarct volumes in the late time window in patients successfully treated with EVT.

Abstract P481: Time to Reperfusion Determines Clinical Outcomes Independent of Post Thrombectomy Infarct Volume

Stroke ◽  
2021 ◽  
Vol 52 (Suppl_1) ◽  
Author(s):  
Shashvat Desai ◽  
Amin N Aghaebrahim ◽  
James E Siegler ◽  
Andre Monteiro ◽  
Ashutosh P Jadhav ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Clinical Outcomes ◽  
Clinical Improvement ◽  
Functional Outcomes ◽  
Time Window ◽  
Infarct Volume ◽  
Late Time ◽  
Inclusion Criteria ◽  
Ischemic Time ◽  
The Impact

Introduction: Late time window thrombectomy trials demonstrated that good functional outcomes can be achieved up to 24 hours from stroke onset in Slow Progressors (small infarct volume and large penumbral volume). In this study, we aim to investigate whether early (<6 hours) recanalization leads to superior functional outcomes compared to delayed recanalization (>6 hours) amongst patients with similar 24-hour infarct volumes post thrombectomy. Methods: We performed a retrospective analysis of a prospectively maintained LVO stroke thrombectomy database across 3 comprehensive stroke centers. Demographic, clinical, radiological, and outcomes data were analyzed. Inclusion criteria were witnessed onset anterior circulation LVO [internal carotid or middle cerebral artery M1] strokes with a good baseline mRS score (0-1) having achieved success recanalization [mTICI 2b-3] and 24-hour infarct volume of ≤10 ml on CT head or MRI. Univariate and multivariate analysis of the impact of time to recanalization on clinical outcomes was performed. Results: Of the 499 LVO strokes undergoing thrombectomy, 30% (148) met inclusion criteria. Mean age was 70 ±14 and median NIHSS score was 17 (14-21). Early recanalization (<6h) was achieved in 65% (96) of patients. Baseline demographic (age: 73 vs 74, p=0.80) and clinical characteristics (NIHSS:16.5 vs 17, p=0.52; 24-h infarct volume: 4.4 vs 4.2 ml, p=0.60) were comparable between early versus late recanalization patients. Rates of early clinical improvement (24-h NIHSS <6) (71% vs 39%, p=0.0007) and mRS 0-2 at 90 days (68% vs 48%, p=0.019) were higher in early recanalizers compared to late recanalizers. Multivariate analysis including age, NIHSS, time to recanalization, and 24-hour infarct volume identified early recanalization as an independent predictor of mRS 0-2 at 90 days (OR-2.41 95% CI 1.89-4.50). Every 1-hour increase in time to recanalization decreased the odds of 90-day mRS 0-2 by 2.2%. Conclusion: Among patients with similar 24-hour infarct volume post thrombectomy (≤10 ml), shorter time to successful recanalization is associated with significantly higher rates of early clinical improvement and mRS 0-2 at 90 days. Increased penumbral ischemic time may have an impact on outcomes post stroke thrombectomy.

scholarly journals Sex-Related Differences in Outcomes After Endovascular Treatment of Patients With Late-Window Stroke

Stroke ◽  
2022 ◽  
Author(s):  
Fouzi Bala ◽  
Ilaria Casetta ◽  
Stefania Nannoni ◽  
Darragh Herlihy ◽  
Mayank Goyal ◽  
...  
Keyword(s):  
Endovascular Treatment ◽  
Scale Score ◽  
Intracranial Hemorrhage ◽  
Time Window ◽  
Intravenous Thrombolysis ◽  
Early Time ◽  
Functional Independence ◽  
Late Time ◽  
Individual Patient Level ◽  
Symptomatic Intracranial Hemorrhage

Background and Purpose: Sex-related differences exist in many aspects of acute stroke and were mainly investigated in the early time window with conflicting results. However, data regarding sex disparities in late presenters are scarce. Therefore, we sought to investigate differences in outcomes between women and men treated with endovascular treatment in the late time window. Methods: Analyses were based on the SOLSTICE Consortium (Selection of Late-Window Stroke for Thrombectomy by Imaging Collateral Extent), which was an individual-patient level analysis of seven trials and registries. Baseline characteristics, 90-day functional independence (modified Rankin Scale score ≤2), mortality, and symptomatic intracranial hemorrhage were compared between women and men. Effect of sex on the association of age and successful reperfusion (final Thrombolysis in Cerebral Infarction 2b–3) with outcomes was assessed using multivariable logistic regression adjusted for age, National Institutes of Health Stroke Scale score, Alberta Stroke Program Early CT Score, time from onset to puncture, occlusion location, intravenous thrombolysis, and successful reperfusion, with interaction terms. Results: Among 608 patients treated with endovascular treatment, 50.5% were women. Women were older than men (median age of 72 versus 68 years, P =0.02) and had a lower prevalence of tandem occlusions (14.0% versus 22.9%, P =0.005). Workflow times were similar between sexes. Adjusted outcomes did not differ between women and men. Functional independence at 90 days was achieved by 127 out of 292 women (43.5%) and 135 out of 291 men (46.4%). Mortality at 90 days (54 [18.5%] versus 48 [16.5%]) and symptomatic intracranial hemorrhage (37 [13.3%] versus 33 [11.6%]) were similar between women and men. There was no sex-by-age interaction on functional outcomes. However, men had higher likelihood of mortality ( P interaction =0.003) and symptomatic intracranial hemorrhage ( P interaction =0.017) with advancing age. Sex did not influence the relation between successful reperfusion and outcomes. Conclusions: In this multicenter analysis of late patients treated with endovascular treatment, sex was not associated with functional outcome. However, sex influenced the association between age and safety outcomes, with men experiencing worse outcomes with advancing age.

Radiographic Characteristics of Mild Ischemic Stroke Patients With Visible Intracranial Occlusion: The INTERRSeCT Study

Stroke ◽  
2021 ◽  
Author(s):  
H. Lee Lau ◽  
Hannah Gardener ◽  
Shelagh B. Coutts ◽  
Vasu Saini ◽  
Thalia S. Field ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Scale Score ◽  
Cerebral Artery ◽  
Odds Ratio ◽  
Arterial Occlusion ◽  
National Institutes Of Health ◽  
Collateral Flow ◽  
Residual Flow ◽  
Intravenous Alteplase ◽  
Multicenter Prospective Study

Background and Purpose: Early neurological deterioration occurs in one-third of mild strokes primarily due to the presence of a relevant intracranial occlusion. We studied vascular occlusive patterns, thrombus characteristics, and recanalization rates in these patients. Methods: Among patients enrolled in INTERRSeCT (Identifying New Approaches to Optimize Thrombus Characterization for Predicting Early Recanalization and Reperfusion With IV Alteplase and Other Treatments Using Serial CT Angiography), a multicenter prospective study of acute ischemic strokes with a visible intracranial occlusion, we compared characteristics of mild (National Institutes of Health Stroke Scale score, ≤5) to moderate/severe strokes. Results: Among 575 patients, 12.9% had a National Institutes of Health Stroke Scale score ≤5 (median age, 70.5 [63–79]; 58% male; median National Institutes of Health Stroke Scale score, 4 [2–4]). Demographics and vascular risk factors were similar between the two groups. As compared with those with a National Institutes of Health Stroke Scale score >5, mild patients had longer symptom onset to assessment times (onset to computed tomography [240 versus 167 minutes] and computed tomography angiography [246 versus 172 minutes]), more distal occlusions (M3, anterior cerebral artery and posterior cerebral artery; 22% versus 6%), higher clot burden score (median, 9 [6–9] versus 6 [4–9]), similar favorable thrombus permeability (residual flow grades I–II, 21% versus 19%), higher collateral flow (9.1 versus 7.6), and lower intravenous alteplase treatment rates (55% versus 85%). Mild patients were more likely to recanalize (revised arterial occlusion scale score 2b/3, 45%; 49% with alteplase) compared with moderate/severe strokes (26%; 29% with alteplase). In an adjusted model for sex, alteplase, residual flow, and time between the two vessel imagings, intravenous alteplase use (odds ratio, 3.80 [95% CI, 1.11–13.00]) and residual flow grade (odds ratio, 8.70 [95% CI, 1.26–60.13]) were associated with successful recanalization among mild patients. Conclusions: Mild strokes with visible intracranial occlusions have different vascular occlusive patterns but similar thrombus permeability compared with moderate/severe strokes. Higher thrombus permeability and alteplase use were associated with successful recanalization, although the majority do not recanalize. Randomized controlled trials are needed to assess the efficacy of new thrombolytics and endovascular therapy in this population.

Abstract 154: Non-Contrast Computed Tomography Based Patient Selection Achieves Similar Outcomes to Advanced Neuroimaging in Late Time Window Endovascular Thrombectomy

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
Mihir Desai ◽  
Khalid Alsahli ◽  
Andrew Cheung ◽  
Jason Wenderoth ◽  
Akshay Kohli ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Patient Selection ◽  
Time Window ◽  
Late Time ◽  
Endovascular Thrombectomy

scholarly journals Acute Stroke Care in the With-COVID-19 Era: Experience at a Comprehensive Stroke Center in Japan

2021 ◽  
Vol 11 ◽  
Author(s):  
Junpei Koge ◽  
Masayuki Shiozawa ◽  
Kazunori Toyoda
Keyword(s):  
Computed Tomography ◽  
Brain Imaging ◽  
Scale Score ◽  
Reperfusion Therapy ◽  
The State ◽  
Imaging Modalities ◽  
Modified Rankin Scale ◽  
State Of Emergency ◽  
Comprehensive Stroke Center ◽  
Stroke Center

Introduction: The pandemic of coronavirus disease 2019 (COVID-19) has had a significant impact on stroke healthcare, including the prehospital care system and in-hospital workflow. Japan experienced the outbreak of COVID-19, and the State of Emergency was declared during April 2020 and May 2020. The aim of the present study was to clarify the effect of the COVID-19 pandemic on a comprehensive stroke center in Japan.Methods: We retrospectively reviewed consecutive patients with acute ischemic stroke admitted in our institute between December 2019 and July 2020. The patients who underwent reperfusion therapy (intravenous thrombolysis and/or mechanical thrombectomy) were divided into the pre-COVID-19 period (December 2019 to March 2020) and the With-COVID-19 period (April 2020 to July 2020). Study outcomes were the number of stroke admissions in our institute, workflow time metrics, the frequency of modified Rankin Scale score 0–2 at discharge, and brain imaging modalities before reperfusion therapy in patients who underwent reperfusion therapy.Results: In our institute, the number of stroke admissions decreased during the State of Emergency and then increased after the lifting of the State of Emergency. Among patients who underwent reperfusion therapy (median age, 77 years; female 27%; median baseline National Institutes of Health Stroke Scale score, 10), times from hospital arrival to imaging [25 (21–33) min vs. 30 (25–38) min, P = 0.03] and to thrombolysis [38 (31–52) min vs. 51 (37–64) min, P = 0.03] were prolonged compared with the pre-COVID-19 period. There was no significant difference in the frequency of modified Rankin Scale score 0–2 at discharge between the two periods (32 vs. 45%, P = 0.21). The proportion of computed tomography vs. magnetic resonance imaging as an emergency brain imaging tool before reperfusion therapy changed, with computed tomography having become predominant in the With-COVID-19 period.Conclusions: In our institute, the number of stroke admissions, workflow time metrics, and imaging modalities for reperfusion therapy were affected by the COVID-19 pandemic.

scholarly journals Stroke Imaging Selection Modality and Endovascular Therapy Outcomes in the Early and Extended Time Windows

Stroke ◽  
2021 ◽  
Vol 52 (2) ◽  
pp. 491-497
Author(s):  
Raul G. Nogueira ◽  
Diogo C. Haussen ◽  
David Liebeskind ◽  
Tudor G. Jovin ◽  
Rishi Gupta ◽  
...  
Keyword(s):  
Scale Score ◽  
Functional Disability ◽  
Time Window ◽  
Imaging Modality ◽  
Time Windows ◽  
Modified Rankin Scale ◽  
Extended Time ◽  
Stroke Therapy ◽  
Advanced Imaging ◽  
Endovascular Stroke Therapy

Background and Purpose: Advanced imaging has been increasingly used for patient selection in endovascular stroke therapy. The impact of imaging selection modality on endovascular stroke therapy clinical outcomes in extended time window remains to be defined. We aimed to study this relationship and compare it to that noted in early-treated patients. Methods: Patients from a prospective multicentric registry (n=2008) with occlusions involving the intracranial internal carotid or the M1- or M2-segments of the middle cerebral arteries, premorbid modified Rankin Scale score 0 to 2 and time to treatment 0 to 24 hours were categorized according to treatment times within the early (0–6 hour) or extended (6–24 hour) window as well as imaging modality with noncontrast computed tomography (NCCT)±CT angiography (CTA) or NCCT±CTA and CT perfusion (CTP). The association between imaging modality and 90-day modified Rankin Scale, analyzed in ordinal (modified Rankin Scale shift) and dichotomized (functional independence, modified Rankin Scale score 0–2) manner, was evaluated and compared within and across the extended and early windows. Results: In the early window, 332 patients were selected with NCCT±CTA alone while 373 also underwent CTP. After adjusting for identifiable confounders, there were no significant differences in terms of 90-day functional disability (ordinal shift: adjusted odd ratio [aOR], 0.936 [95% CI, 0.709–1.238], P =0.644) or independence (aOR, 1.178 [95% CI, 0.833–1.666], P =0.355) across the CTP and NCCT±CTA groups. In the extended window, 67 patients were selected with NCCT±CTA alone while 180 also underwent CTP. No significant differences in 90-day functional disability (aOR, 0.983 [95% CI, 0.81–1.662], P =0.949) or independence (aOR, 0.640 [95% CI, 0.318–1.289], P =0.212) were seen across the CTP and NCCT±CTA groups. There was no interaction between the treatment time window (0–6 versus 6–24 hours) and CT selection modality (CTP versus NCCT±CTA) in terms of functional disability at 90 days ( P =0.45). Conclusions: CTP acquisition was not associated with better outcomes in patients treated in the early or extended time windows. While confirmatory data is needed, our data suggests that extended window endovascular stroke therapy may remain beneficial even in the absence of advanced imaging.

Abstract TP90: Computed Tomography Perfusion Mismatch is Stable Over Time From Onset After Stroke Due to Underestimation of Core Infarct in Late Time Window

Stroke ◽  
2019 ◽  
Vol 50 (Suppl_1) ◽  
Author(s):  
James E Siegler ◽  
Jon Rosenberg ◽  
Andrew Olsen ◽  
Daniel Cristancho ◽  
Johannes Pulst-Korenberg ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Time Window ◽  
Late Time ◽  
Computed Tomography Perfusion ◽  
Core Infarct ◽  
Over Time

scholarly journals Improving the Evaluation of Collateral Circulation by Multiphase Computed Tomography Angiography in Acute Stroke Patients Treated with Endovascular Reperfusion Therapies

2016 ◽  
Vol 5 (3-4) ◽  
pp. 209-217 ◽  
Author(s):  
Alvaro García-Tornel ◽  
Vanessa Carvalho ◽  
Sandra Boned ◽  
Alan Flores ◽  
David Rodríguez-Luna ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Acute Stroke ◽  
Computed Tomography Angiography ◽  
Collateral Circulation ◽  
Infarct Volume ◽  
National Institutes Of Health ◽  
Stroke Patients ◽  
Endovascular Thrombectomy ◽  
The Mean ◽  
Mean Time

Good collateral circulation (CC) is associated with favorable outcomes in acute stroke, but the best technique to evaluate collaterals is controversial. Single-phase computed tomography angiography (sCTA) is widely used but lacks temporal resolution. We aim to compare CC evaluation by sCTA and multiphase CTA (mCTA) as predictors of outcome in endovascular treated patients. Methods: Consecutive endovascular treated patients with M1 middle cerebral artery (MCA) or terminal intracranial carotid artery (TICA) occlusion confirmed by sCTA were included. Two more CTA acquisitions with 8- and 16-second delays were performed for mCTA. Endovascular thrombectomy was performed independently of the CC status according to a local protocol [Alberta Stroke Program Early CT score (ASPECTS) >6, modified Rankin scale (mRS) score <3]. CC on sCTA and mCTA were compared. Results: 108 patients were included. Their mean age was 69.6 ± 13 years and their median National Institutes of Health Stroke Scale (NIHSS) score was 17 (interquartile range 8). 79 (73.1%) had M1 MCA and 29 (26.9%) TICA occlusions. The mean time from symptom onset to CTA was 146.8 ± 96.5 min. On sCTA, 50.9% patients presented good CC vs. 57.5% on mCTA. Good CC status in both sCTA and mCTA had a lower 24-hour infarct volume (27.4 vs. 74.8 cm3 on sCTA, p = 0.04; 17.2 vs. 97.8 cm3 on mCTA, p < 0.01). However, only good CC on mCTA was associated with lower 24-hour (5 vs. 8.5, p = 0.04) and median discharge NIHSS (2 vs. 4.5, p = 0.04) scores and functional independency (mRS score <3) at 3 months (76.9 vs. 23.1%, p < 0.01). In a logistic regression model including age, NIHSS, ASPECTS and recanalization, only age (OR 0.96, 95% CI 0.93-0.99, p = 0.02) and good CC on mCTA (OR 5, 95% CI 1.99-12.6, p < 0.01) were independent predictors of functional outcome at 3 months. Conclusion: CC evaluation by mCTA is a better prognostic marker than CC evaluation by sCTA for clinical and functional endpoints in acute stroke patients treated with endovascular thrombectomy.

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