Diagnostic and prognostic computed tomography imaging markers in basilar artery occlusion (Review)

Filep, Rareș Cristian; Mărginean, Lucian; Stoian, Adina; Bajkó, Zoltán

doi:10.3892/etm.2021.10386

Cited by 10 publications

(11 citation statements)

References 36 publications

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“…This is reasonable since we know that pc-ASPECT detects the areas of brain tissue that are already ischemic before the treatment [19], probably reflecting the status of the collateral circulation [20]. Anyhow, the evaluation of the score is difficult with CT, due to posterior fossa beam hardening artefacts, particularly in the brainstem; these limits may cause low sensitivity and great interobserver variability [21]. On the contrary, MRI is an independent predictor of good clinical outcome prior to endovascular procedures [22], while the probability of good outcome rapidly decreases at each MRI pc-ASPECTS point drop [23].…”

Section: Discussionmentioning

confidence: 99%

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Alexandre

Valente

Consoli

et al. 2021

Life

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Mechanical thrombectomy (MT) is currently the gold standard treatment for ischemic stroke due to large vessel occlusion (LVO). However, the evidence of clinical usefulness of MT in posterior circulation LVO (pc-LVO) is still doubtful compared to the anterior circulation, especially in patients with mild neurological symptoms. The database of 10 high-volume stroke centers in Europe, including a period of three year and a half, was screened for patients with an acute basilar artery occlusion or a single dominant vertebral artery occlusion (“functional” BAO) presenting with a NIHSS ≤10, and with at least 3 months follow-up. A total of 63 patients were included. Multivariate analysis demonstrated that female gender (adjusted OR 0.04; 95% CI 0–0.84; p = 0.04) and combined technique (adj OR 0.001; 95% CI 0–0.81; p = 0.04) were predictors of worse outcome. Higher pc-ASPECTS (adj OR 4.75; 95% CI 1.33–16.94; p = 0.02) and higher Delta NIHSS (adj OR 2.06; 95% CI 1.16–3.65; p = 0.01) were predictors of better outcome. Delta NIHSS was the main predictor of good outcome at 90 days in patients with posterior circulation LVO presenting with NIHSS score ≤ 10.

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Section: Discussionmentioning

confidence: 99%

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Alexandre

Valente

Consoli

et al. 2021

Life

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“…Severe ischemic cerebrovascular diseases (ICD) not only bring physical diseases but also life pressure to patients and their families. BAO accounts for about 1% of all strokes ( 22 ) and for 5% of all intracranial large vessel occlusions (LVO) ( 18 ). Although the efficacy of EVT for BAO has been demonstrated in multiple observational studies ( 6 , 9 , 14 , 23 ), its positive impact on the BA is still a matter of debate ( 23 ).…”

Section: Discussionmentioning

confidence: 99%

“…This result first suggests that each patient may have a unique best treatment time window and we should make the right decision as soon as possible to reduce transport and preoperative preparation time. Secondly, due to the misleading nature of prodromal symptoms related to BAO, clinical diagnosis is often delayed, leading to prolonged time intervals to imaging evaluation and treatment ( 18 ). Finally, currently known puncture methods include radial artery and femoral artery puncture.…”

Section: Discussionmentioning

confidence: 99%

“…Pc-ASPECTS was scored early ischemic changes by evaluating hypoattenuation areas in posterior circulation territories on CTA-SI. One point each is subtracted for early ischemic changes in the left or right thalamus, cerebellum, or posterior cerebral artery (PCA) territory, respectively, and two points in any part of the midbrain or pons ( 18 ) ( Figure 2 ). A pc-ASPECTS score of 10 indicates the absence of visible posterior circulation ischemia, a score of 0 indicates hypoattenuation in all pc-ASPECTS territories.…”

Section: Methodsmentioning

confidence: 99%

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Posterior Circulation ASPECTS on CT Angiography Predicts Futile Recanalization of Endovascular Thrombectomy for Acute Basilar Artery Occlusion

et al. 2022

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BackgroundAcute basilar artery occlusion (BAO) is the most potentially disastrous outcome and has a high risk of recurrence stroke in posterior circulation infarction (PCI). However, the rate of futile recanalization remains high despite successful recanalization. The objective of this study was to investigate 90 days functional outcomes among patients with BAO who underwent endovascular thrombectomy (EVT) and to identify the risk factors associated with futile recanalization.MethodsWe retrospectively analyzed 72 patients with acute BAO who received EVT from January 2018 to June 2021. CT angiography source images posterior circulation Acute Stroke Prognosis Early CT Score (CTA-SI pc-ASPECTS) evaluated the extensive hypoattenuation in patients with BAO. Futile recanalization defined an modified Rankin Scale (mRS) of 3-6 at 90 days despite a successful recanalization. Logistic regression analysis was performed to investigate the predictors of futile recanalization.ResultsOur sample included a total of 55 eligible patients. Patients with poor outcomes showed that the pc-ASPECTS score was lower in patients with poor outcomes than that in patients with good outcomes (P = 0.017). Longer time from symptoms onset-to-the puncture (P = 0.014) and elevation of leucocytes (P = 0.012) were associated with poor outcomes. The multivariable logistic analysis showed that pc-ASPECTS and onset-to-puncture time (OPT) were independent predictors of futile recanalization.ConclusionsThis study suggested that pc-ASPECTS and OPT are independent predictors of futile recanalization after EVT in patients with BAO. The lower pc-ASPECTS score and longer puncture time will have a poor clinical outcome.

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“…A score of 0 indicated no vascular occlusion, and a score of 6 indicated complete occlusion of the posterior circulation, including at least one vertebral artery and the bilateral posterior cerebral arteries. The ponto-midbrain index was also assessed based on the literature [ 15 ]. Based on cranial MR images, 0 indicated no hyperintense infarct areas, 1 indicated a hyperdense area less than 50%, 2 indicated a hyperdense area > 50%, and the pons and midbrain were divided into left and right locations for a total of four locations for scoring.…”

Section: Methodsmentioning

confidence: 99%

Influencing factors of futile recanalization after endovascular therapy for cerebral infarction with posterior circulation occlusion of large vessels: a retrospective study

Xie¹,

Liu²,

Gu³

et al. 2023

BMC Neurol

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Background The optimal treatment for cerebral infarction caused by posterior circulation occlusion of large vessels has not yet been determined. Intravascular interventional therapy is an important treatment for cerebral infarction with posterior circulation occlusion of large vessels. However, endovascular therapy (EVT) of some posterior circulation cerebrovascular is ineffective and eventually become futile recanalization. Therefore, we performed a retrospective study to explore the factors influencing futile recanalization after EVT in patients with posterior circulation large-vessel occlusion. Methods Eighty-six patients with acute cerebral infarction and posterior circulation large vessel occlusion after intravascular intervention were divided into two groups according to their modified Rankin scale (mRS) scores after 3 months: group 1, mRS scores less than or equal to 3 (the effective recanalization group); group 2, mRS scores greater than 3 (the ineffective recanalization group). The basic clinical data, imaging index scores, time from onset to recanalization, and operation time between the two groups were compared and analyzed. Logistic regression was used to analyze the factors influencing indicators of good prognosis, and the ROC curve and Youden index were used to determine the best cutoff value. Results Between the two groups, there were significant differences in the posterior circulation CT angiography (pc-CTA) scores, GCS scores, pontine midbrain index scores, time from discovery to recanalization, operation time, NIHSS score and incidence of gastrointestinal bleeding. The logistic regression revealed that the NIHSS score and time from discovery to recanalization were associated with good prognoses. Conclusion NIHSS score and recanalization time were independent influencing factors of ineffective recanalization of cerebral infarctions caused by posterior circulation occlusion. EVT is relatively effective for cerebral infarction caused by posterior circulation occlusion when the NIHSS score is less than or equal to 16 and the time from onset to recanalization is less than or equal to 570 min.

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Diagnostic and prognostic computed tomography imaging markers in basilar artery occlusion (Review)

Cited by 10 publications

References 36 publications

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Posterior Circulation Endovascular Thrombectomy for Large Vessels Occlusion in Patients Presenting with NIHSS Score ≤ 10

Posterior Circulation ASPECTS on CT Angiography Predicts Futile Recanalization of Endovascular Thrombectomy for Acute Basilar Artery Occlusion

Influencing factors of futile recanalization after endovascular therapy for cerebral infarction with posterior circulation occlusion of large vessels: a retrospective study

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