title: The Basilar Artery on Computed Tomography Angiography Prognostic Score for Basilar Artery Occlusion.
abstract: Basilar artery occlusion is associated with high risk of disability and mortality. This study aimed to assess the prognostic value of a new radiological score: the Basilar Artery on Computed Tomography Angiography (BATMAN) score.
  
  
  
  A retrospective analysis of consecutive stroke patients with basilar artery occlusion diagnosed on computed tomographic angiography was performed. BATMAN score is a 10-point computed tomographic angiography-based grading system which incorporates thrombus burden and the presence of collaterals. Reliability was assessed with intraclass coefficient correlation. Good outcome was defined as modified Rankin Scale score of ≤3 at 3 months and successful reperfusion as thrombolysis in cerebral infarction 2b-3. BATMAN score was externally validated and compared with the Posterior Circulation Collateral score.
  
  
  
  The derivation cohort included 83 patients with 41 in the validation cohort. In receiver operating characteristic (ROC) analysis, BATMAN score had an area under receiver operating characteristic curve of 0.81 (95% confidence interval [CI], 0.7-0.9) in derivation cohort and an area under receiver operating characteristic curve of 0.74 (95% CI, 0.6-0.9) in validation cohort. In logistic regression adjusted for age and clinical severity, BATMAN score of <7 was associated with poor outcome in derivation cohort (odds ratio, 5.5; 95% CI, 1.4-21;P=0.01), in validation cohort (odds ratio, 6.9; 95% CI, 1.4-33;P=0.01), and in endovascular patients, after adjustment for recanalization and time to treatment (odds ratio, 4.8; 95% CI, 1.2-18;P=0.01). BATMAN score of <7 was not associated with recanalization. Interrater agreement was substantial (intraclass coefficient correlation, 0.85; 95% CI, 0.8-0.9). BATMAN score had greater accuracy compared with Posterior Circulation Collateral score (P=0.04).
  
  
  
  The addition of collateral quality to clot burden in BATMAN score seems to improve prognostic accuracy in basilar artery occlusion patients.
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Fana
authors.initials: F
authors.lastname: Alemseged
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Darshan G
authors.initials: DG
authors.lastname: Shah
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Marina
authors.initials: M
authors.lastname: Diomedi
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Sallustio
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Andrew
authors.initials: A
authors.lastname: Bivard
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Gagan
authors.initials: G
authors.lastname: Sharma
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Mitchell
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Dowling
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Steven
authors.initials: S
authors.lastname: Bush
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Bernard
authors.initials: B
authors.lastname: Yan
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Carlo
authors.initials: C
authors.lastname: Caltagirone
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Roberto
authors.initials: R
authors.lastname: Floris
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Mark W
authors.initials: MW
authors.lastname: Parsons
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Levi
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.).
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Davis
authors.affiliation: From the Department of Medicine and Neurology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (F.A., D.G.S., B.Y., S.M.D., B.C.V.C.); Department of Neurology (F.A., M.D., F.S., C.C.) and Department of Diagnostic Imaging and Interventional Radiology (R.F.), University Hospital Tor Vergata, Rome, Italy; I.R.C.C.S., Santa Lucia Foundation, Rome, Italy (M.D., C.C.); Department of Neurology, John Hunter Hospital, University of Newcastle, Australia (A.B., M.W.P., C.R.L.); and Department of Radiology, Royal Melbourne Hospital, University of Melbourne, Parkville, Australia (G.S., P.J.M., R.J.D., S.B.). bruce.campbell@mh.org.au.
authors.forename: Bruce C V
authors.initials: BC
authors.lastname: Campbell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging*; D001488:Basilar Artery / Q000000981:diagnostic imaging*; D000072226:Computed Tomography Angiography / Q000592:standards*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging*
keywords: angiography; basilar artery; prognosis; reperfusion; stroke