TY - JOUR
T1 - Perfusion Imaging Predicts Favorable Outcomes after Basilar Artery Thrombectomy
AU - Cereda, Carlo W.
AU - Bianco, Giovanni
AU - Mlynash, Michael
AU - Yuen, Nicole
AU - Qureshi, Abid Y.
AU - Hinduja, Archana
AU - Dehkharghani, Seena
AU - Goldman-Yassen, Adam E.
AU - Hsieh, Kevin Li Chun
AU - Giurgiutiu, Dan Victor
AU - Gibson, Dan
AU - Carrera, Emmanuel
AU - Alemseged, Fana
AU - Faizy, Tobias D.
AU - Fiehler, Jens
AU - Pileggi, Marco
AU - Campbell, Bruce
AU - Albers, Gregory W.
AU - Heit, Jeremy J.
N1 - Funding Information:
C.W.C. and J.J.H. are members of the Medical and Scientific Advisory Boards of iSchemaView, which produces the software used in this study. J.J.H. is also a consultant for Medtronic and MicroVention, which produce devices used to treat acute ischemic stroke. G.W.A has equity interest in and is a consultant for iSchemaView and is a consultant for Genentech, which produces drugs used to treat acute ischemic stroke. S.D. has received past travel and research support from iSchemaView and reports grant funding support paid to his institution and international patents for mobile stroke detection instrumentation. The other authors have nothing to declare.
Publisher Copyright:
© 2021 American Neurological Association.
PY - 2022/1
Y1 - 2022/1
N2 - 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 < 0.001). No CAPS > 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 2022;91:23–32.
AB - 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 < 0.001). No CAPS > 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 2022;91:23–32.
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U2 - 10.1002/ana.26272
DO - 10.1002/ana.26272
M3 - Article
C2 - 34786756
AN - SCOPUS:85120403642
SN - 0364-5134
VL - 91
SP - 23
EP - 32
JO - Annals of Neurology
JF - Annals of Neurology
IS - 1
ER -