Abstract WP62: Imaging With CT Perfusion Prior to Endovascular Therapy in STRATIS: Time to Rethink?

Background: Different neuroimaging triage strategies, including CT perfusion (CTP), are commonly used prior to endovascular therapy, often tailoring imaging approaches based on time from symptom onset. We analyzed whether the acquisition of CTP prior to endovascular therapy in STRATIS was related to clinical outcomes and if any possible link was noted based on time duration from symptom onset. Methods: The STRATIS Core Lab analyzed all pre-procedural imaging in STRATIS, including the use of CTP. Acquisition of pre-procedural CTP was analyzed with respect to 90-day modified Rankin Score (mRS) clinical outcomes. Subgroup analyses explored whether this relationship was different in the 0-6 versus 6-8 hour interval from symptom onset. Results: Among 984 subjects analyzed in STRATIS, 264 had pre-procedural CTP acquired by the imaging Core Laboratory. No association between CTP acquisition and mRS outcomes at 90 days was observed in the overall study cohort. However, among subjects treated over 6 hours from onset (n=119), a trend toward better outcomes was observed in those with CTP acquisition compared to those without (adjusted common odds ratio 1.86, p=0.092). This association was not present in subjects treated within 6 hours from onset (adjusted common odds ratio 1.10, p=0.498) (Figure). Conclusions: Real-world data from STRATIS reveal that good clinical outcomes after endovascular therapy are not directly contingent on obtaining pre-procedural CTP. Subgroup analyses provide novel data that CTP may not be necessary 0-6 hours from onset, yet CTP may be linked with better outcomes in patients presenting after 6 hours.