{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T11:46:51Z","timestamp":1782820011874,"version":"3.54.5"},"reference-count":24,"publisher":"Oxford University Press (OUP)","issue":"6","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Redes de Investigaci\u00f3n Cooperativa Orientadas a Resultados de Salud (RICORS) en Enfermedades Vasculares Cerebrales","award":["RD24\/0009\/0002"],"award-info":[{"award-number":["RD24\/0009\/0002"]}]},{"name":"Redes de Investigaci\u00f3n Cooperativa Orientadas a Resultados de Salud (RICORS) en Enfermedades Vasculares Cerebrales","award":["RD24\/0009\/0015"],"award-info":[{"award-number":["RD24\/0009\/0015"]}]},{"DOI":"10.13039\/501100004587","name":"Carlos III Health Institute","doi-asserted-by":"publisher","award":["FIS PI21\/01548"],"award-info":[{"award-number":["FIS PI21\/01548"]}],"id":[{"id":"10.13039\/501100004587","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Spanish Ministry of Health co-financed by Carlos III Health Institute","award":["FIS PI21\/01548"],"award-info":[{"award-number":["FIS PI21\/01548"]}]},{"name":"Redes de Investigaci\u00f3n Cooperativa Orientadas a Resultados de Salud (RICORS) en Enfermedades Vasculares Cerebrales","award":["RD24\/0009\/0015"],"award-info":[{"award-number":["RD24\/0009\/0015"]}]},{"name":"Redes de Investigaci\u00f3n Cooperativa Orientadas a Resultados de Salud (RICORS) en Enfermedades Vasculares Cerebrales","award":["RD24\/0009\/0002"],"award-info":[{"award-number":["RD24\/0009\/0002"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>The optimal imaging modality for selecting stroke patients for revascularisation in the extended window remains uncertain. The VESTA study compared simple (non-contrast CT\u00a0+\u00a0CTA) vs advanced imaging (including perfusion) in the extended window in terms of clinical outcomes, mortality and safety.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Patients and methods<\/jats:title>\n                    <jats:p>This multicentre cohort study included 1262 stroke patients (last seen well 6\u201324\u00a0h, NIHSS \u2265 6) from the Catalan Stroke Registry (2019-2021). A central core lab re-evaluated images, and blinded investigators assessed 90-day functional outcomes. Inverse probability weighting (IPW) and multivariable methods were applied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Median age was 76 years, NIHSS 12 and 48% were women. Simple imaging was used in 44% (n\u00a0=\u00a0550), advanced in 56% (n\u00a0=\u00a0712). Simple imaging had higher rates of no arterial occlusion (49% vs 37%, P\u00a0=\u00a0.006) and slightly lower endovascular treatment rates (36% vs 40%, P\u00a0=\u00a0.117). Time metrics were similar. In the IPW analysis, (advanced imaging as reference), simple imaging showed numerically worse point estimates across all outcomes, although most differences did not reach statistical significance: a worse mRS shift (adjusted odds ratio [aOR] 1.17 [95% CI, 0.96\u20131.43]; P\u00a0=\u00a0.11), a lower good functional outcome (mRS 0\u20132; aOR 0.83 [0.66\u20131.06]; P\u00a0=\u00a0.13), a higher mortality (aOR 1.20 [0.91\u20131.58]; P\u00a0=\u00a0.20), more frequent sICH (aOR 1.25 [0.61, 2.57]; P\u00a0=\u00a0.55) and a higher risk of any ICH (aOR 1.57 [1.00\u20132.47]; P\u00a0=\u00a0.05).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Discussion<\/jats:title>\n                    <jats:p>In moderate-to-severe stroke (NIHSS \u2265 6) within 6\u201324\u00a0h, simple imaging did not show a statistically significant difference vs advanced imaging for guiding stroke treatment. However, advanced imaging may improve patient selection for reperfusion and reduce haemorrhagic risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration Information<\/jats:title>\n                    <jats:p>This study was registered at ClinicalTrials.gov under NCT05299034.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/esj\/aakag068","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T20:44:41Z","timestamp":1781729081000},"source":"Crossref","is-referenced-by-count":0,"title":["Simple against advanced imaging for the selection of stroke therapy in the extended window (VESTA study)"],"prefix":"10.1093","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4831-1276","authenticated-orcid":false,"given":"Adri\u00e1n","family":"Valls-Carb\u00f3","sequence":"first","affiliation":[{"name":"Department of Neurosciences, Germans Trias i Pujol University Hospital, 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Germans Trias i Pujol Research Institute, Universitat Aut\u00f2noma de Barcelona , Badalona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pere","family":"Cardona","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Universitari Bellvitge , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan","family":"Flores","sequence":"additional","affiliation":[{"name":"Department of Neurology, Hospital Joan XXIII , Tarragona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carles","family":"Biarnes","sequence":"additional","affiliation":[{"name":"Institut d'Investigaci\u00f3 Biom\u00e8dica de Girona, Hospital Doctor Josep Trueta de Girona , Girona 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