Computed tomography perfusion-defined ischemic core predicts functional outcome after basilar artery thrombectomy

Area of Science:

• Neurology
• Radiology
• Medical Imaging

Background:

• Basilar artery occlusion (BAO) is a severe form of ischemic stroke.
• Accurate assessment of ischemic core volume is crucial for guiding treatment decisions.
• Computed tomography perfusion (CTP) imaging is widely used to estimate infarct size.

Purpose of the Study:

• To determine the optimal threshold for CTP-defined ischemic core in BAO patients.
• To identify CTP parameters that best predict functional outcomes after endovascular thrombectomy.
• To evaluate the utility of Posterior Circulation Alberta Stroke Program Early CT Score (pc-ASPECTS) in BAO.

Main Methods:

• Retrospective analysis of 85 BAO patients treated with endovascular thrombectomy.
• Ischemic core estimation using CTP with thresholds for cerebral blood flow (CBF), cerebral blood volume (CBV), and time to maximum (Tmax).
• Functional outcome assessed by modified Rankin Scale (mRS) at 90 days; pc-ASPECTS was semi-quantified.

Main Results:

• 39 (45.9%) patients achieved a favorable functional outcome (mRS 0-3).
• The CBF < 10 mL/100 g/min threshold (Syngo.via) combined with volume and pc-ASPECTS estimation showed the best predictive performance (AUC 0.86-0.87).
• Optimal cut-off values were ≤ 2.2 for volume and ≥ 7 for pc-ASPECTS.

Conclusions:

• In BAO patients, CTP-defined ischemic core using CBF < 10 mL/100 g/min is a strong predictor of functional outcome post-recanalization.
• The combination of core volume and pc-ASPECTS provides robust prognostic information.
• This approach aids in optimizing treatment selection and predicting recovery after BAO.