Cerebral blood volume index as a predictor of functional independence after basilar artery thrombectomy

Abstract

Background and Purpose:The role of CT perfusion (CTP)in the evaluation of acute basilar artery occlusion (aBAO) patients undergoing endovascular thrombectomy (EVT) is unclear. We investigated the association of individual CTP parameters with functional outcomes in aBAO patients undergoing EVT.Methods: A health system's prospectively collected code stroke registry was used in this retrospective analysis of aBAO patients treated with EVT presenting between January 2017 and February 2021 with pre-EVT CTP. The primary outcome measure was modified Rankin Scale (mRS) score 0-2 at 90 days. Factors with a univariate association (p < .05) with mRS 0-2 were combined in a multivariable regression model to determine independent predictors of 90-day favorable functional outcome.Results: Forty-six subjects, with median age 67 years and median National Institutes of Health Stroke Scale 16, were included, of whom 17 (37%) achieved mRS 0-2 at 90 days.In the multivariable logistic regression model, CTP cerebral blood volume (CBV) index (per 0.1-point increase, odds ratio = 1.843; 95% confidence interval: 1.039, 3.268; p-value .0365) was independently associated with a favorable 90-day outcome. Conclusions:CBV index was independently associated with a favorable 90-day outcome in aBAO patients treated with EVT, a novel finding in this patient population. CBV index may assist in treatment and prognosis discussions and inform future studies investigating the role of CTP in aBAO.

Cerebral blood volume index may be a predictor of independent outcome of thrombectomy in stroke patients with low ASPECTS

“…In patients with internal carotid artery (ICA) or proximal MCA occlusions, CBV index was a surrogate of collateral blood flow status [11]. In acute basilar artery occlusion patients treated with EVT, CBV index was independently associated with a favorable 90-day outcome [7]. Our study showed that in patients with low ASPECTS, CBV index was higher in patients with mRS 0-3 than those with mRS 4-5.…”

“…Volume of infarction core was defined as volume of brain tissue with CBF＜ 30%; Hypoperfusion volume was identified as tissue with a Tmax value > 6 s. Mismatch ratio (mismatch between hypoperfusion and infarction core) was defined as volume of Tmax >6 s/volume of CBF＜ 30%. CBV index was defined as the average CBV in Tm > 6 s region compared to the average CBV in normal brain tissue [7].…”

A Telestroke Nurse and Neuroradiologist Model for Extended Window Code Stroke Triage

“…Clinical and radiological outcome data from our network have been published. [11][12][13][14][15][16][17] We collected data 6 months (November 2020 to April 2021) before implementing the new workflow described hereinafter and 6 months after (May 2021 to October 2021). We included all adult patients with suspected stroke symptoms presenting to one of our stroke network's nonthrombectomy facilities within 4.5 to 24 hours of LKW.…”

“…Our system includes 2 Joint Commission–certified thrombectomy centers: one is a comprehensive stroke center, and the other is thrombectomy capable certified. Clinical and radiological outcome data from our network have been published 11–17. We collected data 6 months (November 2020 to April 2021) before implementing the new workflow described hereinafter and 6 months after (May 2021 to October 2021).…”

Pretreatment CT perfusion collateral parameters correlate with penumbra salvage in middle cerebral artery occlusion

“…[6][7][8][9][10][11] Cerebral blood volume (CBV) index is defined as the average CBV in time to maximum (Tmax) > 6 seconds region compared to the average CBV in normal brain tissue. 12 Hypoperfusion intensity ratio (HIR) was defined as the volume of tissue with Tmax >10 seconds divided by the volume of tissue with Tmax >6 seconds. 13 CBV index and HIR have been proven to be a good surrogate marker for collateral flow in patients with LVO.…”