Noncontrast Computed Tomography vs Computed Tomography Perfusion or Magnetic Resonance Imaging Selection in Late Presentation of Stroke With Large-Vessel Occlusion

Accepted for Publication: September 17, 2021.

Published Online: November 8, 2021. doi:10.1001/jamaneurol.2021.4082

Corresponding Authors: Thanh N. Nguyen, MD, Department of Neurology and Radiology, Boston Medical Center, 725 Albany St, Neurology 7th Floor, Boston, MA 02118 (thanh.nguyen@bmc.org); Raul G. Nogueira, MD, Department of Neurology, Grady Memorial Hospital, Emory University School of Medicine, 80 Jesse Hill Jr Drive SE, Atlanta, GA 30303 (raul.g.nogueira@emory.edu).

Correction: This article was corrected on January 10, 2022, to fix an error in the byline.

Open Access: This is an open access article distributed under the terms of the CC-BY-NC-ND License. © 2021 Nguyen TN et al. JAMA Neurology.

Author Contributions: Drs Nguyen and Qureshi had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Nguyen, Abdalkader, Qureshi, Sheth, Siegler, Castonguay, Jovin, Zaidat, Nogueira.

Acquisition, analysis, or interpretation of data: Nguyen, Nagel, Qureshi, Ribo, Caparros, Haussen, Mohammaden, Sheth, Ortega-Gutierrez, Siegler, Zaidi, Olivé-Gadea, Henon, Möhlenbruch, Castonguay, Nannoni, Kaesmacher, Puri, Seker, Farooqui, Salazar-Marioni, Kuhn, Kaliaev, Farzin, Boisseau, Masoud, Lopez, Rana, Kareem, Sathya, Klein, Kassem, Ringleb, Cordonnier, Gralla, Fischer, Michel, Raymond, Zaidat, Nogueira.

Drafting of the manuscript: Nguyen, Qureshi, Sheth, Castonguay, Farooqui, Salazar-Marioni, Kaliaev, Farzin, Kareem, Klein.

Critical revision of the manuscript for important intellectual content: Abdalkader, Nagel, Ribo, Caparros, Haussen, Mohammaden, Sheth, Ortega-Gutierrez, Siegler, Zaidi, Olivé-Gadea, Henon, Möhlenbruch, Castonguay, Nannoni, Kaesmacher, Puri, Seker, Kuhn, Boisseau, Masoud, Lopez, Rana, Sathya, Kassem, Ringleb, Cordonnier, Gralla, Fischer, Michel, Jovin, Raymond, Zaidat, Nogueira.

Statistical analysis: Qureshi, Sheth, Castonguay, Kaesmacher, Farooqui, Farzin, Nogueira.

Obtained funding: Nguyen, Castonguay, Michel, Zaidat.

Administrative, technical, or material support: Nguyen, Abdalkader, Mohammaden, Ortega-Gutierrez, Siegler, Zaidi, Castonguay, Kaliaev, Lopez, Kareem, Cordonnier, Gralla, Michel.

Supervision: Nguyen, Sheth, Ortega-Gutierrez, Puri, Kuhn, Ringleb, Jovin, Raymond, Zaidat, Nogueira.

Other—data collection: Kareem.

Other–contribution of data: Nagel.

Conflict of Interest Disclosures: Dr Nguyen reported research support from Medtronic and the Society of Vascular and Interventional Neurology with data safety monitoring board involvement for Thrombectomy for Emergent Salvage of Large Anterior Circulation Ischemic Stroke (TESLA), Endovascular Therapy for Low NIHSS Ischemic Strokes (ENDOLOW), a Randomized Controlled Trial to Optimize Patient’s Selection for Endovascular Treatment in Acute Ischemic Stroke (SELECT 2), pRESET for Occlusive Stroke Treatment (PROST), Carotid Revascularization and Medical Management for Asymptomatic Carotid Stenosis Trial (CREST-2), and Workflow Optimization to Reduce Time to Endovascular Reperfusion in Stroke Treatment (WE-TRUST) trials. Dr Nagel reported personal fees for consultancy for Brainomix and payment for lectures including speaker bureaus with Boehringer Ingelheim and Pfizer outside the submitted work. Dr Ribo reported being a cofounder of Anaconda Biomed; a consultant with Methinks, Medtronic, Cerenovus, Apta Targets, Anaconda Biomed, and Philips; and grants from CVAid, outside the submitted work. Dr Haussen reported being a consultant for Stryker, Vesalio, Cerenovus, and Jacobs Institute and holding stock options with VizAi during the conduct of the study. Dr Siegler reported consulting fees from Ceribell and speakers’ bureau involvement with AstraZeneca outside the submitted work. Dr Ortega-Gutierrez reports being a consultant for Medtronic and Stryker Neurovascular and receiving grants from Stryker, IschemiaView, Viz.ai, and Siemens. Dr Möhlenbruch reports consultancy at Medtronic, MicroVention, and Stryker; grants or grants pending from Medtronic, Stryker, Balt, and MicroVention (money paid to his institution); and payment for lectures including service on speakers’ bureaus from Medtronic, MicroVention, and Stryker, outside the submitted work. Dr Zaidat reported consulting fees for Stryker, Medtronic, Cerenovus, and Penumbra; research grants from Stryker, Medtronic, Cerenovus, Penumbra, and Genentech; in addition, Dr Zaidat had a patent for Ischemic Stroke issued. Dr Sheth reported research grants from the National Institutes of Health (grants U18EB029353 and R01NS121154) and American Academy of Neurology/the Society of Vascular and Interventional Neurology and consultancy fees from Penumbra and Cerenovus. Dr Fischer reported research grants from Medtronic (BEYOND SWIFT and SWIFT DIRECT); serving as consultant for Medtronic, Stryker, CSL Behring; and participating in an advisory board for Alexion/Portola outside the submitted work. Dr Jovin reported being an investigator with Stryker (DAWN and AURORA trials); an advisor or investor for Anaconda, Route92, VizAi, FreeOx, Methinks, and Blockade Medical; a recipient of personal fees, data safety monitoring board, and steering committee fees from Cerenovus and grants from Medtronic; an advisor and stockholder for Corindus; and a member of a medical committee for Contego outside the submitted work. Dr Nogueira reported involvement with Stryker as part of the DAWN trial; the Trevo-2 trial and Trevo registry steering committee; Medtronic as part of the SWIFT/SWIFT-PRIME steering committee and STAR trial core laboratory; Penumbra as part of the 3D Trial executive committee; Cerenovus/Neuravi as part of the ENDOLOW Trial, EXCELLENT Registry, and ARISE-2 trial steering committee; Phenox as part of the PROST Trial; Imperative Care as part of the Imperative Trial; and Philips as part of the WE-TRUST trial. Dr Nogueira also reported consulting fees for advisory roles with Anaconda, Biogen, Cerenovus, Genentech, Hybernia, Imperative Care, Medtronic, Phenox, Philips, Prolong Pharmaceuticals, Stryker Neurovascular, Shanghai Wallaby, and Synchron and stock options for advisory roles with Astrocyte, Brainomix, Cerebrotech, Ceretrieve, Corindus Vascular Robotics, Vesalio, Viz-AI, RapidPulse, and Perfuze; and investments in Viz-AI, Perfuze, Cerebrotech, Reist/Q'Apel Medical, Truvic, and Viseon. Dr Kaesmacher reported grants from SAMW/Bangerter Foundation, Swiss Stroke Society, and CTU Bern outside the submitted work. Dr Puri reported personal fees from Stryker Neurovascular, Cerenovus, Medtronic, Merit, CereVasc, Microvention, and Arsenal Medical; stocks with InNeuroCo, Galaxy, NTI, Agile, and Perfuze; and grants from the National Institutes of Health outside the submitted work. Dr Kaliaev reported grants from Medtronic and SVIN during the conduct of the study. Dr Ringleb reported personal fees from Boehringer Ingelheim, Bayer, Bristol Myers Squibb, and Pfizer outside the submitted work. Dr Cordonnier reported personal fees from Boehringer Ingelheim and advisory board participation from Bristol Myers Squibb, AstraZeneca, and Biogen outside the submitted work. Dr Gralla reported grants from Medtronic (SWIFT DIRECT trial) and SNF outside the submitted work. Dr Michel reported grants from Swiss National Science Foundation and Swiss Heart Foundation outside the submitted work. No other disclosures were reported.

Additional Contributions: We would like to acknowledge the following persons who contributed to this work: Oscar Bolanos, Medtronic; Margaret Lavoye, RN, Boston Medical Center; Kristine Below, BS, Umera Paracha, MD, Sakshi Kaul, DO, MS, Mercy Health St. Vincent Medical Center; Viraj M. Moholkar, BS. These individuals were not compensated for their contributions. We express gratitude to all CLEAR study investigators.