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

Abstract

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.

Post-ASPECTS and Post-PC-ASPECTS Predict the Outcome of Anterior and Posterior Ischemic Stroke Following Thrombectomy

“…Thus, post-ASPECTS and post-pc-ASPECTS applied to NCCT have strong prognostic utility in determining clinical outcomes of anterior and posterior circulation AIS, respectively. 17 , 24 , 25 , 35 Moreover, we found that patients in the post-ASPECTS ≥ 7 anterior circulation group also had shorter DRT, PRT, and LKNPT. To our knowledge, there is only one other study that applied pc-ASPECTS to pre-intervention NCCT; they found that patients of BAO with a pc-ASPECTS ≥ 5 could benefit from EVT.…”

“…For acute BAO—the most devastating form of posterior circulation infarction—the following factors have been identified as independent variables impacting functional outcomes: basilar artery recanalization, location of thrombus, length of obstruction, and state of collaterals. 24 However, there are still presently no criteria developed for the appropriate identification of patients who would benefit from EVT. 24 Our current standard of care for the diagnosis of PCS is MRI using diffusion (DWI)- or perfusion-weighted (PWI) imaging sequences, but there are drawbacks such as general inaccessibility in local hospitals, limited practicability for unstable patients, comparatively higher costs, and slow scanning speed.…”

“… 24 However, there are still presently no criteria developed for the appropriate identification of patients who would benefit from EVT. 24 Our current standard of care for the diagnosis of PCS is MRI using diffusion (DWI)- or perfusion-weighted (PWI) imaging sequences, but there are drawbacks such as general inaccessibility in local hospitals, limited practicability for unstable patients, comparatively higher costs, and slow scanning speed. 24 , 30 …”

“… 23 However, due to the low accessibility of MRIs, previous studies have applied PC-ASPECTS to computed tomography angiography source images (CTA-SI) for patients with suspected acute basilar artery occlusion (BAO). 24 Future studies should focus on comparing the efficacy of multimodal MRI, CTA, and CT perfusion (CTP) in predicting clinical outcomes in patients with BAO and determining the most reliable scoring system. 24 To our knowledge, there is only one study that applied PC-ASPECTS to pre-intervention non-contrast CT, a widely used and accessible tool to assess patients before EVT.…”

“… 24 Future studies should focus on comparing the efficacy of multimodal MRI, CTA, and CT perfusion (CTP) in predicting clinical outcomes in patients with BAO and determining the most reliable scoring system. 24 To our knowledge, there is only one study that applied PC-ASPECTS to pre-intervention non-contrast CT, a widely used and accessible tool to assess patients before EVT. 25 Thus, in this study, we aim to determine whether post-ASPECTS in anterior circulation AIS and post-PC-ASPECTS in posterior circulation can serve as prognostic markers of functional outcome after EVT.…”