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

Abstract

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

Acute Basilar Artery Occlusion: Outcome of Mechanical Thrombectomy with Solitaire Stent within 8 Hours of Stroke Onset

“…Several other prognostic factors have been described that predict a good clinical outcome in patients with acute BAO receiving recanalization therapy and include recanalization status, baseline NIHSS score, and the extent of ischemic changes on the pretreatment imaging studies. [18][19][20][21][22] A systematic review including 316 patients in 10 IA thrombolysis studies found that recanalization was associated with a substantial reduction in mortality rates in patients with acute BAO (mortality rate of 87% in non-recanalized compared with 39% in recanalized patients; P Ͻ .001). 18 The overall recanalization rate of these 10 studies was 64%, with a 56% mortality rate.…”

“…The extent of early ischemic changes on pretreatment imaging studies can be used as a prognostic factor of clinical outcome in patients treated with recanalization therapy. [20][21][22] Puetz et al 20 showed that the posterior circulation ASPECTS on CT angiography source images predicts good outcome or death within 1 month in the subgroup of the BASICS registry population. Of 158 patients, 23% (18/78) of patients with a posterior circulation ASPECTS Ն8 had a good outcome, whereas 11% (9/80) of those with a posterior circulation ASPECTS Ͻ8 had a good outcome.…”

A Review of Pre-Intervention Prognostic Scores for Early Prognostication and Patient Selection in Endovascular Management of Large Vessel Occlusion Stroke

“…The PRE and HIAT-2 scores are also specific to the anterior circulation. For posterior circulation stroke, a posterior circulation ASPECTS (pc-ASPECTS) has been developed, although its utility may be mitigated by limitations of CT imaging of the posterior fossa [45, 46]. Incorporation of the pc-ASPECTS performed on CT or pre-ET MRI imaging into pre-intervention prognostic model has not been performed.…”

Cerebellar Hypoperfusion in Migraine Attack: Incidence and Significance

“…score 18,19 with 1 additional slice covering the sensory and motor cortex and frontal superior gyrus. ROIs were semiautomatically positioned on the postprocessed parameter maps, and the numeric values were extracted for TTP, MTT, regional CBF (rCBF), regional CBV (rCBV), and time-to-maximum of the tissue residue function time-to-maximum.…”