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

Puetz, Volker; Sylaja, PN; Hill, Michael D.; Coutts, Shelagh B.; Dzialowski, Imanuel; Becker, U.; Gahn, Georg; Kummer, Ruediger von; Demchuk, Andrew M.

doi:10.3174/ajnr.a1723

Cited by 48 publications

(40 citation statements)

References 25 publications

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“…need for the best outcome predicting neuroimaging model to obtain the optimal therapy. Concordant to other, smaller studies, the infarct detection rate of multimodal CT including CTP was significantly higher in all regions of the PC according to pc-ASPECTS (cerebellum, posterior cerebral artery territory, thalamus, brain stem/midbrain) and, therefore, provides the best outcome prediction [6,10] .…”

Section: Discussionsupporting

confidence: 64%

Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

Sporns¹,

Schmidt

Minnerup

et al. 2016

Cerebrovasc Dis

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Background and Purpose: Computed tomography perfusion (CTP) has a high diagnostic value in the detection of acute ischemic stroke in the anterior circulation. However, the diagnostic value in suspected posterior circulation (PC) stroke is uncertain, and whole brain volume perfusion is not yet in widespread use. We therefore studied the additional value of whole brain volume perfusion to non-contrast CT (NCCT) and CT angiography source images (CTA-SI) for infarct detection in patients with suspected acute ischemic PC stroke. Methods: This is a retrospective review of patients with suspected stroke in the PC in a database of our stroke center (n = 3,011) who underwent NCCT, CTA and CTP within 9 h after stroke onset and CT or MRI on follow-up. Images were evaluated for signs and pc-ASPECTS locations of ischemia. Three imaging models - A (NCCT), B (NCCT + CTA-SI) and C (NCCT + CTA-SI + CTP) - were compared with regard to the misclassification rate relative to gold standard (infarction in follow-up imaging) using the McNemar's test. Results: Of 3,011 stroke patients, 267 patients had a suspected stroke in the PC and 188 patients (70.4%) evidenced a PC infarct on follow-up imaging. The sensitivity of Model C (76.6%) was higher compared with that of Model A (21.3%) and Model B (43.6%). CTP detected significantly more ischemic lesions, especially in the cerebellum, posterior cerebral artery territory and thalami. Conclusions: Our findings in a large cohort of consecutive patients show that CTP detects significantly more ischemic strokes in the PC than CTA and NCCT alone.

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Section: Discussionsupporting

confidence: 64%

Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

Sporns¹,

Schmidt

Minnerup

et al. 2016

Cerebrovasc Dis

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“…18 However, the feasibility of MRI acquisition is limited in these frequently unstable patients. 19,20 We have recently demonstrated that CTA-SIs increase the sensitivity for early ischemic changes in the posterior circulation compared with noncontrast CT. 12,16 Compared with CTA-SI, perfusion CT techniques may provide additional diagnostic and prognostic information in patients with acute posterior circulation stroke. 21,22 The comparison of CTA, perfusion CT, and multimodal MRI to predict functional outcome and treatment response in patients with BAO could be the subject of future studies.…”

Section: Discussionmentioning

confidence: 99%

“…Images were analyzed in a 3-readers consensus setting by stroke neurologists experienced in the interpretation of CTA-SI in acute ischemic stroke (A.M.D., I.D., V.P.). 12,16 Readers were blinded to clinical information. We graded hypoattenuating areas in posterior circulation territories with the pc-ASPECTS score and the Ponsmidbrain-index as described before (Figure 1).…”

Section: Image Analysismentioning

confidence: 99%

Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion

Puetz

Khomenko

Hill

et al. 2011

Stroke

102

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on behalf of the Basilar Artery International Cooperation Study (BASICS) GroupBackground 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 Ն8 versus Ͻ8. 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 Ն8. Patients with a pc-ASPECTS Ն8 more often had a favorable outcome than patients with a pc-ASPECTS Ͻ8 (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 Ն8 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 Ն6 versus Ͻ6 predicted a favorable outcome (adjusted RR, 3.1; 95% CI, 1.2-7.5). Conclusions-pc-ASPECTS

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“…Doing nothing usually leads to death, but intervention, even if successful, can leave the patient in a vegetative state, especially when the lesions are widespread. The ASPECT scoring system in the posterior fossa lesion published by the Calgary team 25 suggests that with an ASPECT score Ͻ8, no good clinical outcome can be ex- …”

Section: Imaging-based Patient Selectionmentioning

confidence: 99%

Rescue, Combined, and Stand-Alone Thrombectomy in the Management of Large Vessel Occlusion Stroke Using the Solitaire Device: A Prospective 50-Patient Single-Center Study

Costalat

Machi

Lobotesis

et al. 2011

Stroke

189

137

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Background and Purpose-Large vessel occlusion in ischemic stroke is associated with a high degree of morbidity. When intravenous thrombolysis fails, mechanical thrombectomy can provide an alternative and synergistic method for flow restoration. In this study we evaluate the safety and efficacy of our stroke management protocol (RECOST study). Methods-Fifty consecutive ischemic stroke patients with large vessel occlusion were included. After clinical and MRI imaging assessment, 3 treatment strategies were selected according to time of symptom onset and location of vessel occlusion: rescue therapy; combined therapy; and stand-alone thrombectomy (RECOST study). MRI ASPECT score Ͻ5 was the main exclusion criterion. Mechanical thrombectomy was performed exclusively with the Solitaire flow restoration device. Clinical outcome was assessed after treatment, on day 1, and at discharge. Results-Mean patient age was 67.6 years, mean NIHSS score was 14.7, and mean ASPECT score was 6 on presentation.Vessel occlusions were in the middle cerebral artery (40%), the internal carotid artery (28%), and the basilar artery (32%). Rescue treatment represented 24%, combined therapy represented 56%, and stand-alone thrombectomy represented 20%. Mean recanalization time from symptoms onset was 377 minutes, with overall recanalization rate TICI 3 of 84%. NIHSS score at discharge was 6.5, with 60% of patients demonstrating NIHSS score 0 to 1 or an improvement of Ͼ9 points. Symptomatic complication rate was 10%. At 3 months, 54% of patients had a modififed Rankin scale score of 0 to 2, with an overall mortality rate of 12%. Conclusions-The present integrated stroke management protocol (RECOST study) demonstrated rapid, safe, and effective recanalization. We postulate that the Solitaire device contributed to high recanalization and patient selection using MRI ASPECT score to low and complication rates, therefore avoiding futile and dangerous interventions. (Stroke.

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

Cited by 48 publications

References 25 publications

Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

Computed Tomography Perfusion Improves Diagnostic Accuracy in Acute Posterior Circulation Stroke

Extent of Hypoattenuation on CT Angiography Source Images in Basilar Artery Occlusion

Rescue, Combined, and Stand-Alone Thrombectomy in the Management of Large Vessel Occlusion Stroke Using the Solitaire Device: A Prospective 50-Patient Single-Center Study

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