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Computed tomography perfusion-defined ischemic core predicts functional outcome after basilar artery thrombectomy
Pengjun Chen1, Xia Li1, Yechao Huang1
1Zhejiang Key Laboratory of Imaging and Interventional Medicine, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Hospital of Zhejiang University, Lishui, China.
Insights
The optimal threshold for computed tomography perfusion (CTP) defined ischemic core in basilar artery occlusion (BAO) patients predicts functional outcomes. A cerebral blood flow (CBF) < 10 mL/100 g/min threshold best predicts favorable outcomes after endovascular 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.
Purpose:
This study aimed to determine the optimal threshold for computed tomography perfusion (CTP)-defined ischemic core in patients with basilar artery occlusion (BAO) that predicts functional outcome.
Methods:
A retrospective analysis was conducted on BAO patients who underwent endovascular thrombectomy at our stroke center between January 2018 and March 2024. Ischemic core was estimated using following thresholds: cerebral blood flow (CBF) < 10 or 15 mL/100 g/min by Syngo.via, cerebral blood volume < 1.2 mL/100 mL by Syngo.via, and time to maximum (Tmax) > 10 s by RAPID. A favorable functional outcome was defined as a modified Rankin Scale score of 0-3 at 90-day post-onset. The Posterior Circulation Alberta Stroke Program Early computed tomography Score (pc-ASPECTS) was semi-quantified to assess ischemic changes. Statistical analysis included intraclass correlation coefficient (ICC) and receiver operating characteristic analyses.
Results:
A total of 85 patients were enrolled, and 39 (45.9%) had a favorable functional outcome. The ICC for pc-ASPECTS based on four core approaches between junior and senior observers ranged from 0.90 to 0.96. For the classification of favorable outcome, the volume and pc-ASPECTS core estimation approach (CBF < 10 mL/100 g/min by Syngo.via) had the best performance, with the largest area under the curve of 0.86 [(95% confidence intervals, 0.78-0.94); p < 0.001] and 0.87 [(95% confidence intervals, 0.80-0.94); p < 0.001], with a cut-off value of ≤ 2.2 (78.3%% sensitivity, 84.6% specificity), and ≥ 7 (92.3% sensitivity, 65.2% specificity).
Conclusion:
In BAO patients following successful recanalization, the volume and pc-ASPECTS core estimation approach (CBF < 10 mL/100 g/min by Syngo.via) demonstrated the strongest predictive value for favorable functional outcomes.
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