CT Angiography Source Images Predict Final Infarct Extent in Patients with Basilar Artery Occlusion

Background and Purpose— The posterior circulation Acute Stroke Prognosis Early CT Score (pc-ASPECTS) quantifies the extent of early ischemic changes in the posterior circulation with a 10-point grading system. We hypothesized that pc-ASPECTS applied to CT angiography source images predicts functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). Methods— BASICS was a prospective, observational registry of consecutive patients with acute symptomatic basilar artery occlusion. Functional outcome was assessed at 1 month. We applied pc-ASPECTS to CT angiography source images of patients with CT angiography for confirmation of basilar artery occlusion. We calculated unadjusted and adjusted risk ratios (RRs) of pc-ASPECTS dichotomized at ≥8 versus <8. Primary outcome measure was favorable outcome (modified Rankin Scale scores 0–3). Secondary outcome measures were mortality and functional independence (modified Rankin Scale scores 0–2). Results— Of 158 patients included, 78 patients had a CT angiography source images pc-ASPECTS ≥8. Patients with a pc-ASPECTS ≥8 more often had a favorable outcome than patients with a pc-ASPECTS <8 (crude RR, 1.7; 95% CI, 0.98–3.0). After adjustment for age, baseline National Institutes of Health Stroke Scale score, and thrombolysis, pc-ASPECTS ≥8 was not related to favorable outcome (RR, 1.3; 95% CI, 0.8–2.2), but it was related to reduced mortality (RR, 0.7; 95% CI, 0.5–0.98) and functional independence (RR, 2.0; 95% CI, 1.1–3.8). In post hoc analysis, pc-ASPECTS dichotomized at ≥6 versus <6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2–7.5). Conclusions— pc-ASPECTS on CT angiography source images independently predicted death and functional independence at 1 month in the CT angiography subgroup of patients in the BASICS registry.

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Endovascular Treatment Outcome and CT Angiography Findings in Acute Basilar Artery Occlusion with and without Underlying Intracranial Atherosclerotic Stenosis

Journal of Vascular and Interventional Radiology ◽

10.1016/j.jvir.2019.09.002 ◽

2020 ◽

Vol 31 (5) ◽

pp. 747-753

Author(s):

Yen-Heng Lin ◽

Kuo-Wei Chen ◽

Sung-Chun Tang ◽

Chung-Wei Lee

Keyword(s):

Treatment Outcome ◽

Endovascular Treatment ◽

Ct Angiography ◽

Basilar Artery ◽

Artery Occlusion ◽

Basilar Artery Occlusion ◽

Intracranial Atherosclerotic Stenosis ◽

Atherosclerotic Stenosis

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Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2015-011883 ◽

2015 ◽

Vol 8 (8) ◽

pp. 783-786 ◽

Cited By ~ 31

Author(s):

Nitin Goyal ◽

Georgios Tsivgoulis ◽

Chris Nickele ◽

Vinodh T Doss ◽

Dan Hoit ◽

...

Keyword(s):

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Ct Angiography ◽

Basilar Artery ◽

Functional Independence ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Stroke Severity ◽

Nihss Score

IntroductionThe natural history of acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) is poor. Endovascular reperfusion therapy (EVT) improves recanalization rates in patients with emergent large vessel intracranial occlusion.ObjectiveTo examine the hypothesis that good collateral patterns identified by pretreatment CT angiography (CTA) might be associated with favorable outcomes after EVT.MethodsWe conducted a retrospective chart review of patients presenting with AIS due to BAO in a tertiary care stroke center during a 4-year period. BAO was diagnosed by CTA in all cases. Admission stroke severity was documented using the National Institute of Health Stroke Scale (NIHSS) score. Pretreatment collateral score for posterior circulation was defined as follows: 0, no posterior communicating artery (PCOM); 1, unilateral PCOM; 2, bilateral PCOM. Favorable outcome was defined as modified Rankin Scale score of 0–2 at 3 months.ResultsA total of 21 patients with AIS due to BAO (age range 31–84 years, median admission NIHSS score: 18 points, range 2–38) underwent EVT. Eleven of 21 patients (52.4%) had bilateral PCOMs, while unilateral PCOM was seen in 3 patients (14.3%). Patients with bilateral PCOMs tended (p=0.261) to have less severe stroke at admission than those with absent/unilateral PCOM (median NIHSS score 18 vs 27 points). Neurological improvement during hospitalization (quantified by the median decrease in NIHSS score) and the rate of 3-month functional independence were greater in patients with good collaterals (16 vs 0 points (p=0.016) and 72.7% vs 0% (p=0.001)).ConclusionsThe presence of bilateral PCOMs on pretreatment CTA appears to be associated with more favorable outcomes in BAO treated with EVT.

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Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion

Stroke ◽

10.1161/strokeaha.107.511162 ◽

2008 ◽

Vol 39 (9) ◽

pp. 2485-2490 ◽

Cited By ~ 134

Author(s):

Volker Puetz ◽

P.N. Sylaja ◽

Shelagh B. Coutts ◽

Michael D. Hill ◽

Imanuel Dzialowski ◽

...

Keyword(s):

Functional Outcome ◽

Ct Angiography ◽

Basilar Artery ◽

Artery Occlusion ◽

Basilar Artery Occlusion

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Value of Posterior circulation ASPECTS and Pons-Midbrain Index on non-contrast CT and CT Angiography Source Images in patients with basilar artery occlusion recanalized after mechanical thrombectomy

Radiología (English Edition) ◽

10.1016/j.rxeng.2018.06.001 ◽

2019 ◽

Vol 61 (2) ◽

pp. 143-152

Author(s):

M.F. Werner ◽

A. López-Rueda ◽

F.X. Zarco ◽

J. Blasco ◽

L San Román ◽

...

Keyword(s):

Ct Angiography ◽

Basilar Artery ◽

Mechanical Thrombectomy ◽

Artery Occlusion ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Contrast Ct

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CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study

International Journal of Stroke ◽

10.1177/1747493016669886 ◽

2016 ◽

Vol 12 (2) ◽

pp. 145-151 ◽

Cited By ~ 5

Author(s):

Lars P Pallesen ◽

Andrei Khomenko ◽

Imanuel Dzialowski ◽

Jessica Barlinn ◽

Kristian Barlinn ◽

...

Keyword(s):

Acute Stroke ◽

International Cooperation ◽

Ct Angiography ◽

Basilar Artery ◽

Fatal Outcome ◽

Artery Occlusion ◽

Favourable Outcome ◽

Posterior Circulation ◽

Basilar Artery Occlusion ◽

Risk Ratios

Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. <8) and Pons-Midbrain Index (<3 vs. ≥3) with mortality and favourable outcome (modified Rankin Scale score 0–3) at one month. Results Of 619 patients in the Basilar Artery International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56–3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24–0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46–0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39–3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46–1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.

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