1. The charlotte large artery occlusion endovascular therapy outcome score compares favorably to the critical area perfusion score for prognostication before basilar thrombectomy.
- Author
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Karamchandani RR, Satyanarayana S, Yang H, Rhoten JB, Strong D, Singh S, Clemente JD, Defilipp G, Hazim M, Patel NM, Bernard J, Stetler WR, Parish JM, Blackwell TA, Heit JJ, Albers GW, Saba K, Guzik AK, Wolfe SQ, and Asimos AW
- Subjects
- Humans, Aged, Treatment Outcome, Retrospective Studies, Reproducibility of Results, Thrombectomy adverse effects, Thrombectomy methods, Basilar Artery diagnostic imaging, Perfusion, Stroke, Arterial Occlusive Diseases etiology, Endovascular Procedures adverse effects, Endovascular Procedures methods, Vertebrobasilar Insufficiency diagnostic imaging, Vertebrobasilar Insufficiency therapy, Vertebrobasilar Insufficiency etiology
- Abstract
Introduction: The Critical Area Perfusion Score (CAPS) predicts functional outcomes in vertebrobasilar thrombectomy patients based on computed tomography perfusion (CTP) hypoperfusion. We compared CAPS to the clinical-radiographic Charlotte Large artery occlusion Endovascular therapy Outcome Score (CLEOS)., Methods: Acute basilar thrombosis patients from January 2017-December 2021 were included in this retrospective analysis from a health system's stroke registry. Inter-rater reliability was assessed for 6 CAPS raters. A logistic regression with CAPS and CLEOS as predictors was performed to predict 90-day modified Rankin Scale (mRS) score 4-6. Area under the curve (AUC) analyses were performed to evaluate prognostic ability., Results: 55 patients, mean age 65.8 (± 13.1) years and median NIHSS score 15.5
5-24 , were included. Light's kappa among 6 raters for favorable versus unfavorable CAPS was 0.633 (95% CI 0.497-0.785). Increased CLEOS was associated with elevated odds of a poor outcome (odds ratio (OR) 1.0010, 95% CI 1.0007-1.0014, p<0.01), though CAPS was not (OR 1.0028, 95% CI 0.9420-1.0676, p=0.93). An overall favorable trend was observed for CLEOS (AUC 0.69, 95% CI 0.54-0.84) versus CAPS (AUC 0.49, 95% CI 0.34-0.64; p=0.051). Among 85.5% of patients with endovascular reperfusion, CLEOS had a statistically higher sensitivity than CAPS at identifying poor 90-day outcomes (71% versus 21%, p=0.003)., Conclusions: CLEOS demonstrated better predictive ability than CAPS for poor outcomes overall and in patients achieving reperfusion after basilar thrombectomy., Competing Interests: Declaration of Competing Interest Dr. Joe Bernard declares stock/stock options from Viz.Ai and personal fees from Stryker, Terumo, and Rapid AI. Dr. Jeremy Heit is a consultant for Medtronic and MicroVention and a member of the Scientific and Advisory Board for iSchemaView. Dr. Gregory Albers is a consultant for Genentech, iSchemaView, and Biogen and has equity interest in iSchemaView. All other authors report no disclosures., (Copyright © 2023 Elsevier Inc. All rights reserved.)- Published
- 2023
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