Extent of hypoattenuation on CT angiography source images predicts functional outcome in patients with basilar artery occlusion.
OBJECTIVE
Quantification of early ischemic changes (EIC) may predict functional outcome in patients with basilar artery occlusion (BAO). We tested the validity of a novel CT score, the posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS).


METHODS
Pc-ASPECTS allots the posterior circulation 10 points. Two points each are subtracted for EIC in midbrain or pons and 1 point each for EIC in left or right thalamus, cerebellum or PCA-territory, respectively. We studied 2 different populations: (1) patients with suspected vertebrobasilar ischemia and (2) patients with BAO. We applied pc-ASPECTS to noncontrast CT (NCCT), CT angiography source images (CTASI), and follow-up image by 3-reader consensus. We calculated sensitivity for ischemic changes and analyzed the predictivity of pc-ASPECTS for independent (modified Rankin Scale [mRS] score </=2) and favorable (mRS score </=3) outcome.


RESULTS
Of 130 patients with suspected vertebrobasilar ischemia, 72% (94) had posterior circulation stroke, 8% (10) transient ischemic attack, and 20% (26) nonischemic etiology. Sensitivity for ischemic changes was improved with CTASI compared to NCCT (65% [95% CI, 57% to 73%] versus 46% [95% CI, 37% to 55%], respectively). Pc-ASPECTS score on CTASI but not NCCT predicted functional independence (OR 1.58; P=0.005 versus 1.22; P=0.42, respectively). Of 46 patients with BAO, 52% (12/23) with CTASI pc-ASPECTS score >/=8 but only 4% (1/23) with a score <8 had favorable functional outcome (RR 12.1; 95% CI, 1.7 to 84.9). This difference was consistent in 21 patients with angiographic recanalization (RR 7.7; 95% CI, 1.1 to 52.1).


CONCLUSIONS
The CTASI pc-ASPECTS score may identify BAO patients unlikely to have a favorable outcome despite recanalization.
Puetz
Volker
V
University of Technology Dresden, Department of Neurology, Dresden University Stroke Center, Fetscherstrasse 74, 01307 Dresden, Germany. volker.puetz@neuro.med.tu-dresden.de
Sylaja
P N
PN
Coutts
Shelagh B
SB
Hill
Michael D
MD
Dzialowski
Imanuel
I
Mueller
Pia
P
Becker
Ulf
U
Urban
Gabriele
G
O'Reilly
Christine
C
Barber
Philip A
PA
Sharma
Pranshu
P
Goyal
Mayank
M
Gahn
Georg
G
von Kummer
Ruediger
R
Demchuk
Andrew M
AM
D000368:Aged; D000792:Angiography; D001488:Basilar Artery / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology; D001933:Brain Stem / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D002531:Cerebellum / Q000098:blood supply / Q000000981:diagnostic imaging / Q000473:pathology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000379:methods; D011237:Predictive Value of Tests; D011379:Prognosis; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000503:physiopathology