title: Extent of hypoattenuation on CT angiography source images in basilar artery occlusion: prognostic value in the Basilar Artery International Cooperation Study.
abstract: OBJECTIVE
  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.
authors.affiliation: University of Technology Dresden, Dresden University Stroke Center, Department of Neurology, Fetscherstr. 74, 01307 Dresden, Germany. volker.puetz@neuro.med.tu-dresden.de
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
authors.forename: Andrei
authors.initials: A
authors.lastname: Khomenko
authors.forename: Michael D
authors.initials: MD
authors.lastname: Hill
authors.forename: Imanuel
authors.initials: I
authors.lastname: Dzialowski
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.forename: Christian
authors.initials: C
authors.lastname: Weimar
authors.forename: Christine A C
authors.initials: CA
authors.lastname: Wijman
authors.forename: Heinrich P
authors.initials: HP
authors.lastname: Mattle
authors.forename: Stefan T
authors.initials: ST
authors.lastname: Engelter
authors.forename: Keith W
authors.initials: KW
authors.lastname: Muir
authors.forename: Thomas
authors.initials: T
authors.lastname: Pfefferkorn
authors.forename: David
authors.initials: D
authors.lastname: Tanne
authors.forename: Kristina
authors.initials: K
authors.lastname: Szabo
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Ruediger
authors.initials: R
authors.lastname: von Kummer
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.forename: Wouter J
authors.initials: WJ
authors.lastname: Schonewille
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001488:Basilar Artery / Q000000981:diagnostic imaging*; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D011857:Radiographic Image Interpretation, Computer-Assisted; D012042:Registries; D012307:Risk Factors; D014057:Tomography, X-Ray Computed; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000401:mortality