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.

Endovascular treatment of acute ischemic stroke in the posterior circulation

“…To evaluate the extent of hypoattenuation in the NCCT the posterior circulation-Alberta Stroke Program Early CT score (pc-ASPECTS) and Pons-Midbrain Index (PMI) were applied to the pre- and post-procedural radiological examinations (supplement). 9,10 For evaluation of the collateral circulation, the BATMAN score was used, which takes into account the thrombus burden and the collateral circulation (supplement). The cohort was divided and analyzed according to two outcome groups: good outcome, defined as mRS ≤ 2, or bad outcome, defined as mRS > 2, but also according to unsuccessful recanalization, defined as mTICI 0–2a and successful recanalization as mTICI 2b/3.…”

Current endovascular strategies for posterior circulation large vessel occlusion stroke: report of the Society of NeuroInterventional Surgery Standards and Guidelines Committee

“…41 (BASICS) study, evaluation of comatose patients with basilar occlusions using CTA showed the extent of brainstem ischemia on source images was related to mortality and poor outcome. 43 The use of CTA in patients with possible BAO has also been found to be cost effective. 44 Historically, the use of CT perfusion (CTP) in the posterior circulation has been of limited value.…”

Neuroimaging Predictors of Clinical Outcome in Acute Basilar Artery Occlusion

“…In a retrospective review of the BASICS registry, a PMI <3 in comatose patients was associated with reduced mortality (adjusted RR, 0.66; 95% CI, 0.46–0.96) (9). In another retrospective study of 16 patients with vertebrobasilar occlusion treated with intra-arterial therapy (IAT), hypoattenuation evaluated in the pons on CTA-SI was the only independent predictor of outcome (10).…”