title: Proposal for a Vascular Computed Tomography-Based Grading System in Posterior Circulation Stroke: A Single-Center Experience.
abstract: OBJECTIVE
  The aim of this study is to investigate the role of a computed tomography angiography (CTA)-based approach in patients undergoing mechanical thrombectomy for vertebrobasilar stroke treatment.
  
  
  METHODS
  A CTA and digital subtraction angiography (DSA) retrospective analysis of patients with acute vertebrobasilar stroke treated with thrombectomy was performed. A modified Rankin Scale score of 3 or lower at 3 months was considered as favorable outcome. The posterior circulation ASPECTS (pc-ASPECTS) was evaluated on CTA and vertebrobasilar segments involved in the occlusion were assessed using a 6-point posterior circulation computed tomography angiography (pc-CTA) vascular score aimed at evaluating the posterior circulation vascular pattern including collaterals. The primary end point was the correlation between pc-CTA and outcome; secondary end points included the concordance between CTA-DSA images and the correlation between pc-ASPECTS and outcome.
  
  
  RESULTS
  Fifteen patients with vertebrobasilar stroke were retrospectively analyzed. All patients in coma showed a bad outcome (P = .01) and all patients with an alert state showed a good outcome (P = .004). An excellent interobserver agreement for pc-CTA (P = .001) was observed with poor interobserver agreement for pc-ASPECTS (P = .21). No significant correlations between pc-ASPECTS and clinical outcome were observed. Patients with good outcome had a lower pc-CTA (P = .02). The patency of the distal third of the basilar artery and both posterior cerebral arteries was related with good outcome.
  
  
  CONCLUSIONS
  The pc-CTA seems to have prognostic value in patients with vertebrobasilar stroke undergoing mechanical thrombectomy. It may be used as an additional prognostic triage technique in this subgroup of stroke patients.
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy. Electronic address: valeriodaros@hotmail.com.
authors.forename: Valerio
authors.initials: V
authors.lastname: Da Ros
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Meschini
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Gandini
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Costantino
authors.initials: C
authors.lastname: Del Giudice
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Garaci
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Stanzione
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Barbara
authors.initials: B
authors.lastname: Rizzato
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Marina
authors.initials: M
authors.lastname: Diomedi
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Simonetti
authors.affiliation: Department of Diagnostic Imaging and Interventional Radiology, University of Rome Tor Vergata, Rome, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Floris
authors.affiliation: Stroke Unit, Department of Neuroscience, University of Rome Tor Vergata, Rome, Italy; Fondazione Santa Lucia IRCCS, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sallustio
mesh_terms: D000328:Adult; D000368:Aged; D015901:Angiography, Digital Subtraction; D020520:Brain Infarction / Q000000981:diagnostic imaging* / Q000601:surgery; D002533:Cerebral Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D020521:Stroke / Q000000981:diagnostic imaging* / Q000601:surgery; D017131:Thrombectomy / Q000379:methods*; D016896:Treatment Outcome
keywords: ASPECTS; Stroke; basilar artery; computed tomography angiography; neurothrombectomy