Video
Pooja Khatri, MD
Dr. Khatri discusses the evidence for selecting patients for acute endovascular therapy based on stroke severity.
“PISTE raises the question of how much imaging is necessary,” Dr. Kent commented.
“The PISTE results are exciting. A lot of us believe that all we need to know is that there is a blockage in a target vessel,” Dr. Smith said. “If we have that information, then we can identify a population of patients who will benefit from [thrombectomy]. CT angiography is simple and can easily fit into work flows.”
“PISTE used a very simple imaging system that makes thrombectomy even more applicable and generalizable to less resourced health systems,” Dr. Saver said. “Although the results from PISTE were not internally statistically significant because the trial ended early, the results were consistent with the external studies of thrombectomy, so it provides further evidence for benefit from thrombectomy.” And because the consistent results were achieved with simpler imaging, it suggests simpler imaging may be all that is needed.
“That’s a major question to wrestle with,” Dr. Saver suggested. “We need additional trials with a head-to-head comparison of simpler and more sophisticated imaging so we can tailor treatment to patients who would benefit from simpler and faster imaging.”
—Mitchel L. Zoler