Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion.
BACKGROUND
The natural history of acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) is poor. Endovascular reperfusion therapy (EVT) improves recanalization rates in patients with emergent large vessel intracranial occlusion.


OBJECTIVE
To examine the hypothesis that good collateral patterns identified by pretreatment CT angiography (CTA) might be associated with favorable outcomes after EVT.


METHODS
We conducted a retrospective chart review of patients presenting with AIS due to BAO in a tertiary care stroke center during a 4-year period. BAO was diagnosed by CTA in all cases. Admission stroke severity was documented using the National Institute of Health Stroke Scale (NIHSS) score. Pretreatment collateral score for posterior circulation was defined as follows: 0, no posterior communicating artery (PCOM); 1, unilateral PCOM; 2, bilateral PCOM. Favorable outcome was defined as modified Rankin Scale score of 0-2 at 3 months.


RESULTS
A total of 21 patients with AIS due to BAO (age range 31-84 years, median admission NIHSS score: 18 points, range 2-38) underwent EVT. Eleven of 21 patients (52.4%) had bilateral PCOMs, while unilateral PCOM was seen in 3 patients (14.3%). Patients with bilateral PCOMs tended (p=0.261) to have less severe stroke at admission than those with absent/unilateral PCOM (median NIHSS score 18 vs 27 points). Neurological improvement during hospitalization (quantified by the median decrease in NIHSS score) and the rate of 3-month functional independence were greater in patients with good collaterals (16 vs 0 points (p=0.016) and 72.7% vs 0% (p=0.001)).


CONCLUSIONS
The presence of bilateral PCOMs on pretreatment CTA appears to be associated with more favorable outcomes in BAO treated with EVT.
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Nitin
N
Goyal
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA Second Department of Neurology, "Attikon" Hospital, School of Medicine, University of Athens, Athens, Greece.
Georgios
G
Tsivgoulis
Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
Chris
C
Nickele
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
Vinodh T
VT
Doss
Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
Dan
D
Hoit
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
Andrei V
AV
Alexandrov
Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
Adam
A
Arthur
Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA.
Lucas
L
Elijovich
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000628:therapy; D002533:Cerebral Angiography / Q000379:methods*; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D000072226:Computed Tomography Angiography / Q000379:methods*; D057510:Endovascular Procedures / Q000379:methods*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D007839:Functional Laterality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery* / Q000628:therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery
D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator
CT Angiography; Stroke; Thrombectomy; Thrombolysis