In:
Stroke, Ovid Technologies (Wolters Kluwer Health), Vol. 53, No. Suppl_1 ( 2022-02)
Abstract:
Introduction: Acute ischemic stroke due to basilar artery occlusion (AIS-BAO) results in significant morbidity and mortality. Endovascular thrombectomy (ET) has not been shown to improve outcomes in AIS-BAO patients in randomized trials, which may be due to insufficient selection before ET. We determined whether the Critical Area Perfusion Score (CAPS) and posterior circulation ASPECTS (PC-ASPECTS) predict a favorable response to ET. Methods: We performed a multicenter retrospective study of AIS-BAO patients with perfusion imaging prior to ET. PC-ASPECTS was determined on NCCT by evaluating the cerebellum (1 point/hemisphere), pons (2 points), midbrain (2 points), thalamus (1 point/hemisphere), and posterior cerebral artery (1 point/hemisphere) territories, and points were subtracted for hypodensity in these regions. CAPS was quantified severe hypoperfusion (Tmax 〉 10s) in cerebellum (1 point/hemisphere), pons (2 points), midbrain and/or thalamus (2 points). The primary outcome was a favorable outcome 90-days after ET (modified Rankin Scale [mRS] 0-3). Results: 89 patients were included. CAPS (AUC=0.70 [95% CI: 0.59-0.80]; p=0.002) and PC-ASPECTS (AUC=0.63 [95% CI: 0.52-0.75] ; p=0.034) both predicted favorable outcomes in a receiver operating curve analysis, but there was no difference between the two (p=0.434). After dichotomization, patients with favorable CAPS (≤3) and PC-ASPECTS (≥7) were more likely to achieve a good functional outcome after successful reperfusion after ET (Figure). However, an unfavorable CAPS ( 〉 3) was associated with poor outcomes despite successful thrombectomy in all patients, whereas 22% of patients with unfavorable PC-ASPECTS ( 〈 7) still achieved favorable outcomes with reperfusion after ET (Figure). Conclusions: CAPS and PC-ASPECTS both identify AIS-BAO patients who are likely to have a favorable clinical response to ET. CAPS, but not PC-ASPECTS, appears to accurately identify a subgroup in whom ET may be futile.
Type of Medium:
Online Resource
ISSN:
0039-2499
,
1524-4628
DOI:
10.1161/str.53.suppl_1.126
Language:
English
Publisher:
Ovid Technologies (Wolters Kluwer Health)
Publication Date:
2022
detail.hit.zdb_id:
1467823-8
