Abstract 1122‐000120: Clinical and Neuroperfusion Predictors of Functional Outcome and Final Infarct Volume in Posterior Circulation Stroke
Introduction : Computed tomography perfusion (CTP) is considered standard of care in patient selection for mechanical thrombectomy (MT) in anterior circulation large vessel occlusion (LVO) ischemic strokes presenting after 6 hours from symptom onset. Its role in triaging patients is uncertain in posterior circulation stroke. The aim of this study is to assess the value of the admission CTP sequences in predicting clinical and radiological outcomes in posterior circulation LVO. Methods : We performed a retrospective cohort study of a prospectively maintained stroke database of patients who were diagnosed with a posterior circulation LVO and underwent MT. We included patients with a CTP on arrival and follow‐up imaging (brain MRI or CT) after MT. Baseline clinical as well as CTP parameters (cerebral blood flow [CBF]; cerebellar blood volume [CBV]; time at maximum intensity [Tmax]) at different thresholds were estimated using post‐processing RAPID software. Final stroke volume was quantified on follow‐up imaging using the DWI sequence or plain CT. Good functional outcome was defined as using the mRS of 0–2 at 90 days. Results : Out of 81 patients with posterior circulation LVO who underwent MT, 23 had CTP on arrival along with follow‐up brain imaging (16 had MRI, and 7 had CT) and were included in the final analysis. Lower age, BMI, NIHSS on arrival, and faster time to reperfusion were significantly associated with better mRS at 90 days (p<0.05). Tmax>6 (p = 0.08) and Tmax>8 (0.057) seconds trended towards predicting good mRS at 90 days. None of the CTP parameters showed a predictive value for final stroke volume on follow‐up imaging. Conclusions : Age, NIHSS on arrival, and time to reperfusion were superior to neuroperfusion parameters in predicting good mRS at 90 days in patients who underwent MT in posterior circulation LVO. Since CTP might have limitations in the posterior fossa for accurate estimation of ischemic volumes, plain CT or acute MRI brain may represent a diagnostic tool for patient selection in posterior circulation strokes at this moment.