title: CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study.
abstract: Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. <8) and Pons-Midbrain Index (<3 vs. ≥3) with mortality and favourable outcome (modified Rankin Scale score 0-3) at one month. Results Of 619 patients in the Basilar Artery International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56-3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24-0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46-0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39-3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46-1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.
authors.affiliation: 1 Department of Neurology, University of Technology Dresden, Dresden, Germany.
authors.forename: Lars P
authors.initials: LP
authors.lastname: Pallesen
authors.affiliation: 2 Department of Neurology, University of Regensburg, Regensburg, Germany.
authors.forename: Andrei
authors.initials: A
authors.lastname: Khomenko
authors.affiliation: 3 Department of Neurology, Elblandklinikum Meissen, Meissen, Germany.
authors.forename: Imanuel
authors.initials: I
authors.lastname: Dzialowski
authors.affiliation: 1 Department of Neurology, University of Technology Dresden, Dresden, Germany.
authors.forename: Jessica
authors.initials: J
authors.lastname: Barlinn
authors.affiliation: 1 Department of Neurology, University of Technology Dresden, Dresden, Germany.
authors.forename: Kristian
authors.initials: K
authors.lastname: Barlinn
authors.affiliation: 1 Department of Neurology, University of Technology Dresden, Dresden, Germany.|4 Calgary Stroke Program, University of Calgary, Calgary, Canada.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Zerna
authors.affiliation: 5 St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
authors.forename: Erik Jrj
authors.initials: EJ
authors.lastname: van der Hoeven
authors.affiliation: 6 Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands.|7 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.affiliation: 6 Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands.
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kapelle
authors.affiliation: 8 Centre Hospitalier Universitaire Vaudois, Centre Cérébrovasculaire, Lausanne, Switzerland.
authors.forename: Patrik
authors.initials: P
authors.lastname: Michel
authors.affiliation: 1 Department of Neurology, University of Technology Dresden, Dresden, Germany.
authors.forename: Ulf
authors.initials: U
authors.lastname: Bodechtel
authors.affiliation: 4 Calgary Stroke Program, University of Calgary, Calgary, Canada.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Demchuk
authors.affiliation: 5 St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.|6 Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands.
authors.forename: Wouter
authors.initials: W
authors.lastname: Schonewille
authors.affiliation: 1 Department of Neurology, University of Technology Dresden, Dresden, Germany.
authors.forename: Volker
authors.initials: V
authors.lastname: Puetz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001488:Basilar Artery / Q000000981:diagnostic imaging; D001921:Brain / Q000000981:diagnostic imaging*; D003128:Coma / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality*; D000072226:Computed Tomography Angiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012042:Registries; D012720:Severity of Illness Index; D014715:Vertebrobasilar Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality*; D055815:Young Adult
keywords: Basilar artery occlusion; CTA source images; coma; imaging scores; ischemic stroke; thrombolysis