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Published on: February 17, 2013
Computed Tomography Perfusion Parameters: A Potential Tool for Treatment Selection in Basilar Artery Occlusion
Cong Luo1, Thanh N Nguyen2,3, Rui Li1
1Department of Neurology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, China.
Insights
Computed tomography perfusion (CTP) parameters like CAPS and PMT hypoperfusion can predict outcomes in basilar artery occlusion (BAO). Severe hypoperfusion does not exclude patients from benefiting from thrombectomy.
Area of Science:
- Neurology
- Radiology
- Interventional Cardiology
Background:
- Basilar artery occlusion (BAO) is a severe form of ischemic stroke with poor prognosis.
- Computed tomography perfusion (CTP) imaging offers valuable insights into tissue perfusion and salvageability.
- Identifying optimal candidates for thrombectomy in BAO is crucial for improving outcomes.
Purpose of the Study:
- To evaluate the association between CTP parameters and clinical outcomes in patients with BAO.
- To identify CTP parameters that predict benefit from endovascular thrombectomy in BAO.
- To refine patient selection for thrombectomy in BAO.
Main Methods:
- Post-hoc analysis of ATTENTION trial data with available CTP parameters.
- Evaluation of CTP metrics including Tmax, rCBF, CAPS, CTP-pc-ASPECTS, and PMT hypoperfusion.
- Multivariable Firth logistic regression to assess associations and treatment interactions for favorable outcomes (mRS 0-3 at 90 days).
Main Results:
- Lower CAPS, smaller rCBF <34% volume, and higher CTP-pc-ASPECTS were linked to favorable outcomes.
- Thrombectomy showed a higher likelihood of favorable outcomes with increasing CAPS (Tmax >6s) and in cases of PMT hypoperfusion.
- Significant treatment interactions were observed for CAPS (Tmax >6s) and PMT hypoperfusion, indicating thrombectomy benefit in these subgroups.
Conclusions:
- Higher CAPS correlated with decreased favorable outcomes but identified patients who benefit more from thrombectomy.
- Severe hypoperfusion (indicated by CAPS and PMT hypoperfusion) should not be a contraindication for endovascular treatment in BAO.
- CTP parameters can aid in selecting BAO patients who are most likely to benefit from thrombectomy.
Objective:
This study aimed to evaluate the association between computed tomography perfusion (CTP) parameters and outcomes in basilar artery occlusion (BAO), and to select patients with BAO who may benefit from thrombectomy.
Methods:
We performed a post-hoc analysis of patients from the ATTENTION trial with available admission CTP data. CTP parameters evaluated included time to maximum (Tmax) >6 s/8 s/10 s, relative cerebral blood flow (rCBF) <20%/30%/34%/38%/50%, Critical Area Perfusion Score (CAPS), and CTP-posterior circulation acute stroke prognosis early computed tomography score (CTP-pc-ASPECTS), pons-midbrain-thalamus (PMT) hypoperfusion. Multivariable Firth logistic regression was used to analyze associations between CTP parameters and outcomes and to explore treatment interactions. The primary outcome was favorable outcome, defined as modified Rankin Scale score of 0-3, at 90 days.
Results:
The study included 109 patients (70 thrombectomy, 39 control). Multivariable analysis showed that lower CAPS, smaller rCBF <34% volume, and higher CTP-pc-ASPECTS were associated with favorable outcome. Patients who underwent thrombectomy had a higher likelihood of favorable outcome with increasing CAPS (Tmax > 6 s) compared to control (Pinteraction = 0.048 for continuous variable). When CAPS (Tmax > 6 s) was treated as a categorical variable, the interaction remained significant (Pinteraction = 0.03). Similarly, the treatment effect was also modified by PMT hypoperfusion (Tmax >6 s) (Pinteraction = 0.03). In patients with CAPS (Tmax >6 s) >3 or with PMT hypoperfusion (Tmax >6 s), thrombectomy was associated with favorable outcome.
Interpretation:
Higher CAPS correlated with a decrease in the rate of favorable outcomes. However, patients with higher CAPS were more likely to benefit from thrombectomy compared to medical management alone, suggesting that severe hypoperfusion should not preclude endovascular treatment. ANN NEUROL 2025;98:185-196.
