Basilar artery occlusion: Prognostic signs of severity on computed tomography

Poletti, Pierre–Alexandre; Pereira, Vítor Mendes; Lövblad, Karl‐Olof; Canel, Lucie; Sztajzel, Roman; Becker, Minerva; Perneger, Thomas; Platon, Alexandra

doi:10.1016/j.ejrad.2015.03.004

Cited by 4 publications

(2 citation statements)

References 15 publications

(28 reference statements)

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“…9 Our findings also support the results of another study, investigating prognostic signs of severity on computed tomography (CT) in patients with a BAO treated with IVT, IAT, IVT followed by IAT or without treatment. 18 This study reported longer clots in poor outcome patients (mRS 4–6) compared with favourable outcome patients (mean 16.5 vs. 11.4 mm) but the difference was not statistically significant, probably because of the small study sample ( n = 37).…”

Section: Discussioncontrasting

confidence: 56%

Clot length predicts recanalisation but not outcome after basilar artery occlusion

Hoeven

Algra

Vos

et al. 2016

European Stroke Journal

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Introduction: The aim of our study was to evaluate the effect of clot length on both recanalisation and outcome in acute basilar artery occlusion (BAO). Patients and methods: One hundred forty-nine patients with an acute basilar artery occlusion from the Basilar Artery International Cooperation Study (BASICS) were included. Clot length was assessed on computed tomographic angiography. Thrombus length was divided in tertiles and was related to recanalisation and outcome at 1 month, with Poisson regression. Modified Rankin scale scores of 4 or 5, or death were considered poor outcomes. Additionally, clot length was analysed as a continuous variable. Results: Forty-nine patients (33%) had a short (4-11 mm), 50 (34%) an intermediate (12-22 mm), and 50 (34%) a long clot (23 mm). Multivariable analyses showed a significantly lower probability of recanalisation but no statistically significant difference in poor outcome for patients with a long clot compared with patients with a short clot (RR 0.64, 95% CI: 0.42-0.98 and RR 1.10, 95% CI: 0.88-1.37, respectively). No statistically significant differences were found for patients with an intermediate clot length compared with patients with a short clot length (RR 0.97, 95% CI: 0.75-1.25 and RR 1.11, 95% CI: 0.88-1.40, respectively). Analyses of clot length as a continuous variable showed a 10% reduction in chance of recanalisation and a 2% increase in risk of poor outcome with every centimeter increase in clot length (RR 0.90, 95% CI: 0.78-1.04 and RR 1.02, 95% CI: 0.98-1.05, respectively). Conclusions: Clot length predicted recanalisation but not outcome at 1 month in patients with a BAO. We found 2% more poor outcome and 10% less recanalisation with every centimeter increase in clot length.

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Section: Discussioncontrasting

confidence: 56%

Clot length predicts recanalisation but not outcome after basilar artery occlusion

Hoeven

Algra

Vos

et al. 2016

European Stroke Journal

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“…Third, the overwhelming majority of studies were conducted in the anterior circulation and there are few studies reporting on thrombus density and recanalization success in the posterior circulation [ 25 , 26 , 27 ]. One of the reasons may be that the basilar artery is prone to beam hardening artifacts in the posterior fossa [ 28 ] which are not present in the anterior circulation.…”

Section: Discussionmentioning

confidence: 99%

Thrombus Density in Acute Basilar Artery Occlusion Depends on Slice Thickness and the Method of Manual Thrombus Delineation

Shen

Meyne

Jansen

et al. 2022

Life

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Introduction: High thrombus attenuation on CT has been suggested as a predictor of successful recanalization. It is as well speculated that thrombi of different density may be susceptible to different methods of mechanical thrombectomy. In this study we sought to determine the effect of different methods of manual thrombus delineation and reconstructed slice thickness on thrombus density. Material and Methods: Fifty-six patients with acute occlusion of the basilar artery treated with endovascular therapy were retrospectively included. Clinical, demographic, radiological and outcome parameters were collected. Two raters measured absolute and relative thrombus density employing three different methods (one region of interest, three regions of interest, whole thrombus delineation) and using three different reconstructed slice thicknesses (0.625, 2.5 and 5 mm) of the original admission CT. Results: Thirty-nine patients were successfully recanalized (thrombolysis in cerebral infarction score ≥ 2b). Good clinical outcome (modified Rankin scale ≤ 2) occurred significantly more often in the recanalized group (36 vs. 6%, p = 0.023, Fisher’s exact test), in the non-recanalized group symptomatic intracranial hemorrhage occurred more often (9 vs. 29%, p = 0.001, Fisher’s exact test). Absolute and relative thrombus density were largely different between methods and slice thicknesses. Multiple regression showed a decrease of thrombus density with increasing slice thickness (β = −3.98, p < 0.001) and logistic regression showed a statistically significant but very small relation between density and recanalization (β = 0.006, odds ratio (95% confidence interval) = 1.006 (1.003–1.01), p < 0.001). Conclusions: The methods for manual thrombus delineation and reconstructed slice thickness had a significant influence on absolute and relative thrombus density. Density alone may be of limited value as a predictive marker for recanalization success in acute occlusion of the basilar artery. Standards for density measurements must be defined when comparing different studies and when evaluating different methods of mechanical thrombectomy.

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