1. Perfusion Imaging Predicts Favorable Outcomes after Basilar Artery Thrombectomy
- Author
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Michael Mlynash, Bruce C.V. Campbell, Abid Y Qureshi, Dan-Victor Giurgiutiu, Gregory W. Albers, Adam E. Goldman-Yassen, Daniel Gibson, Marco Pileggi, Tobias D Faizy, Archana Hinduja, Giovanni Bianco, Carlo W. Cereda, Jens Fiehler, Emmanuel Carrera, Fana Alemseged, Jeremy J Heit, Seena Dehkharghani, Nicole Yuen, and Kevin Li Chun Hsieh
- Subjects
Adult ,Male ,medicine.medical_specialty ,Perfusion Imaging ,Neuroimaging ,Perfusion scanning ,Cohort Studies ,Interquartile range ,Internal medicine ,medicine.artery ,Vertebrobasilar Insufficiency ,Basilar artery ,Humans ,Medicine ,Aged ,Retrospective Studies ,Thrombectomy ,Stroke scale ,business.industry ,Endovascular Procedures ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Magnetic Resonance Imaging ,Confidence interval ,Treatment Outcome ,Neurology ,Reperfusion ,Cardiology ,Female ,Neurology (clinical) ,Tomography, X-Ray Computed ,business ,Perfusion - Abstract
OBJECTIVE Perfusion imaging identifies anterior circulation stroke patients who respond favorably to endovascular thrombectomy (ET), but its role in basilar artery occlusion (BAO) is unknown. We hypothesized that BAO patients with limited regions of severe hypoperfusion (time to reach maximum concentration in seconds [Tmax] > 10) would have a favorable response to ET compared to patients with more extensive regions involved. METHODS We performed a multicenter retrospective cohort study of BAO patients with perfusion imaging prior to ET. We prespecified a Critical Area Perfusion Score (CAPS; 0-6 points), which quantified severe hypoperfusion (Tmax > 10) in cerebellum (1 point/hemisphere), pons (2 points), and midbrain and/or thalamus (2 points). Patients were dichotomized into favorable (CAPS ≤ 3) and unfavorable (CAPS > 3) groups. The primary outcome was a favorable functional outcome 90 days after ET (modified Rankin Scale = 0-3). RESULTS One hundred three patients were included. CAPS ≤ 3 patients (87%) had a lower median National Institutes of Health Stroke Scale score (NIHSS; 12.5, interquartile range [IQR] = 7-22) compared to CAPS > 3 patients (13%; 23, IQR = 19-36; p = 0.01). Reperfusion was achieved in 84% of all patients, with no difference between CAPS groups (p = 0.42). Sixty-four percent of reperfused CAPS ≤ 3 patients had a favorable outcome compared to 8% of nonreperfused CAPS ≤ 3 patients (odds ratio [OR] = 21.0, 95% confidence interval [CI] = 2.6-170; p 3 patients had a favorable outcome, regardless of reperfusion. In a multivariate regression analysis, CAPS ≤ 3 was a robust independent predictor of favorable outcome after adjustment for reperfusion, age, and pre-ET NIHSS (OR = 39.25, 95% CI = 1.34->999, p = 0.04). INTERPRETATION BAO patients with limited regions of severe hypoperfusion had a favorable response to reperfusion following ET. However, patients with more extensive regions of hypoperfusion in critical brain regions did not benefit from endovascular reperfusion. ANN NEUROL 2021.
- Published
- 2021
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