scholarly journals COMPUTED TOMOGRAPHY ANGIOGRAPHY COLLATERAL SCORES AND OUTCOMES AFTER ACUTE REPERFUSION THERAPIES FOR BASILAR ARTERY OCCLUSION

2018 ◽  
Author(s):  
Octavio Marques Pontes-Neto
Keyword(s):  
Computed Tomography ◽  
Basilar Artery ◽  
Computed Tomography Angiography ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

Abstract WMP20: The Basilar Artery on Computed Tomography Angiography (batman) Prognostic Score for Basilar Artery Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (suppl_1) ◽  
Author(s):  
Fana Alemseged ◽  
Darshan G Shah ◽  
Marina Diomedi ◽  
Fabrizio Sallustio ◽  
Andrew Bivard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Basilar Artery ◽  
Computed Tomography Angiography ◽  
Prognostic Score ◽  
Artery Occlusion ◽  
Clinical Severity ◽  
Basilar Artery Occlusion ◽  
Derivation Cohort ◽  
Poor Outcome ◽  
Prognostic Accuracy

Background: Basilar artery occlusion (BAO) is associated with high risk of disability and mortality. This study aimed to assess the prognostic value of a new radiological score: the “Basilar Artery on Computed Tomography Angiography score (BATMANs)”. Methods: A retrospective analysis of consecutive stroke patients with a diagnosis of BAO on CT angiography (CTA) was performed. BATMANs is a 10 point CTA-based grading system. We allocated 1 point for each patent segment (proximal, middle and distal) of the basilar artery, 1 point for any patent intracranial vertebral arteries (VA), 1 point for each posterior cerebral artery (PCA) and 2 points for each posterior communicating artery (PcoM) or 1 point for hypoplastic PcoM (<1 mm diameter). Two investigators reviewed the CTA images blinded to clinical outcome. Reliability was assessed with intraclass coefficient correlation (ICC). Good outcome was defined as modified Rankin Scale≤3 at 3 months; successful reperfusion as thrombolysis in cerebral infarction 2b-3. BATMANs was externally validated and compared with the Posterior Circulation Collateral score (PC-CS). Results: The derivation cohort (DC) included 83 patients with 41 in the validation cohort (VC). In receiver-operating-characteristic (ROC) analysis, BATMANs had an area-under-curve (AUC) of 0.81 (95%CI 0.7-0.9) in DC and an AUC of 0.74 (95%CI 0.6-0.9) in VC. BATMANs<7 was the optimal threshold for poor outcome in DC (sensitivity=84%, specificity=76%). In logistic regression adjusted for age and clinical severity, BATMANs<7 was associated with poor outcome in DC (OR 5.5, 95% CI 1.4 -21; p=0.01), in VC (OR 6.9, 95% CI 1.4-33; p=0.01) and among endovascular patients (OR 3.8, 95%CI 1.0-14; p=0.05). BATMANs was independently associated with functional outcome after adjustment for revascularization and time to treatment (OR 4.8, 95%CI 1-18; p=0.01); however, it was not associated with recanalization. Inter-rater agreement was excellent (ICC 0.85, 95% CI 0.76-0.89). BATMANs showed higher accuracy in comparison with PC-CS (p=0.03). Conclusions: The addition of collateral quality to clot burden in BATMANs appears to improve prognostic accuracy in BAO patients.

scholarly journals The Basilar Artery on Computed Tomography Angiography Prognostic Score for Basilar Artery Occlusion

Stroke ◽  
2017 ◽  
Vol 48 (3) ◽  
pp. 631-637 ◽  
Author(s):  
Fana Alemseged ◽  
Darshan G. Shah ◽  
Marina Diomedi ◽  
Fabrizio Sallustio ◽  
Andrew Bivard ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Basilar Artery ◽  
Computed Tomography Angiography ◽  
Prognostic Score ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

scholarly journals Outcomes of Endovascular Thrombectomy for Basilar Artery Occlusion

2020 ◽  
Vol 47 (4) ◽  
pp. 479-485
Author(s):  
Christopher R. Pasarikovski ◽  
Houman Khosravani ◽  
Leodante da Costa ◽  
Chinthaka Heyn ◽  
Stefano M. Priola ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Functional Outcome ◽  
Basilar Artery ◽  
Treatment Time ◽  
Intravenous Thrombolysis ◽  
Artery Occlusion ◽  
Posterior Circulation ◽  
Basilar Artery Occlusion ◽  
Related Complication ◽  
Endovascular Thrombectomy

ABSTRACT:Background and Purpose:Large prospective observational studies have cast doubt on the common assumption that endovascular thrombectomy (EVT) is superior to intravenous thrombolysis for patients with acute basilar artery occlusion (BAO). The purpose of this study was to retrospectively review our experience for patients with BAO undergoing EVT with modern endovascular devices.Methods:All consecutive patients undergoing EVT with either a second-generation stent retriever or direct aspiration thrombectomy for BAO at our regional stroke center from January 1, 2013 to March 1, 2019 were included. The primary outcome measure was functional outcome at 1 month using the modified Rankin Scale (mRS) score. Multivariable logistic regression was used to assess the association between patient characteristics and dichotomized mRS.Results:A total of 43 consecutive patients underwent EVT for BAO. The average age was 67 years with 61% male patients. Overall, 37% (16/43) of patients achieved good functional outcome. Successful reperfusion was achieved in 72% (31/43) of cases. The median (interquartile range) stroke onset to treatment time was 420 (270–639) minutes (7 hours) for all patients. The procedure-related complication rate was 9% (4/43). On multivariate analysis, posterior circulation Alberta stroke program early computed tomography score and Basilar Artery on Computed Tomography Angiography score were associated with improved functional outcome.Conclusion:EVT appears to be safe and feasible in patients with BAO. Our finding that time to treatment and successful reperfusion were not associated with improved outcome is likely due to including patients with established infarcts. Given the variability of collaterals in the posterior circulation, the paradigm of utilizing a tissue window may assist in patient selection for EVT. Magnetic resonance imaging may be a reasonable option to determine the extent of ischemia in certain situations.

Basilar artery occlusion: Prognostic signs of severity on computed tomography

2015 ◽  
Vol 84 (7) ◽  
pp. 1345-1349 ◽  
Author(s):  
Pierre-Alexandre Poletti ◽  
Vitor Mendes Pereira ◽  
Karl-Olof Lovblad ◽  
Lucie Canel ◽  
Roman Sztajzel ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion

Computed Tomography Attenuation Values in Acute Basilar Artery Occlusion

1994 ◽  
Vol 4 (6) ◽  
pp. 407-411 ◽  
Author(s):  
Karl-Olof Lövblad ◽  
Christoph Ozdoba ◽  
Luca Remonda ◽  
Gerhard Schroth
Keyword(s):  
Computed Tomography ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Basilar Artery Occlusion ◽  
Attenuation Values

Abstract WP84: MRI Based Scores Outperform CTA Based Scores in Predicting Outcome After Basilar Artery Occlusion

Stroke ◽  
2020 ◽  
Vol 51 (Suppl_1) ◽  
Author(s):  
Katarina Dakay ◽  
Amanda Ng ◽  
Justin F Fraser ◽  
Ali Mahta ◽  
Michael Reznik ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Basilar Artery ◽  
Artery Occlusion ◽  
Prognostic Scores ◽  
Basilar Artery Occlusion ◽  
Roc Curve Analysis ◽  
Ct Angiogram ◽  
Magnetic Resonance Imaging Mri ◽  
Basilar Occlusion ◽  
Noninvasive Neuroimaging

Introduction: Clinical outcomes in patients with acute basilar occlusion (BAO) vary widely; several prognostic scores based on noninvasive imaging have been proposed. We aimed to compare the predictive value of several noninvasive neuroimaging scores in patients with BAO. Methods: We performed a single-center retrospective cohort study including all patients with acute BAO from 2015-2019. Using available clinical radiographic data, we calculated the following scores based on computed tomography (CT) and CT angiogram: Goyal posterior communicating artery score, posterior circulation collateral score, Basilar Artery on Computed Tomography Angiography (BATMAN) score, pc-ASPECTS score, and pons-midbrain index. We also calculated the following scores based on diffusion-weighted (DWI) magnetic resonance imaging (MRI): Bern DWI score, MRI pc-ASPECTS, and pons-midbrain index on DWI. We then used logistic regression with area under the ROC curve analysis to determine the accuracy of each score in predicting favorable 3-month outcome (modified Rankin Scale 0-2). Results: Of 39 patients in our cohort, 92.3% underwent endovascular treatment (n=36) and 35.8% (n=14) had a favorable 3-month outcome. The Bern DWI score (AUC 0.790, 95% CI 0.619-0.960), pc-ASPECTS on MRI (AUC 0.880, 95% CI 0.601-0.958), and pons-midbrain index on MRI (AUC 0.764, 95% CI 0.594-0.934) accurately predicted 3-month outcome when analyzed as raw scores (Figure 1).: Conclusion: MRI scores more strongly predict outcome in BAO as compared to CTA collateral scores. Larger prospective studies are needed to confirm our findings.

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