Perfusion Imaging Predicts Favorable Outcomes after Basilar Artery Thrombectomy

被引：33

作者：

Cereda, Carlo W. ^{[1
]}

Bianco, Giovanni ^{[1
]}

Mlynash, Michael ^{[2
]}

Yuen, Nicole ^{[2
]}

Qureshi, Abid Y. ^{[3
]}

Hinduja, Archana ^{[4
]}

Dehkharghani, Seena ^{[5
]}

Goldman-Yassen, Adam E. ^{[6
]}

Hsieh, Kevin Li-Chun ^{[7
]}

Giurgiutiu, Dan-Victor ^{[8
]}

Gibson, Dan ^{[9
]}

Carrera, Emmanuel ^{[10
]}

Alemseged, Fana ^{[11
]}

Faizy, Tobias D. ^{[12
]}

Fiehler, Jens ^{[12
]}

Pileggi, Marco ^{[13
]}

Campbell, Bruce

Albers, Gregory W. ^{[2
]}

Heit, Jeremy J. ^{[14
]}

机构：

[1] Med Caposervizio Neurocentro EOC Svizzera It, Neurol, Stroke Ctr, Lugano, Switzerland

[2] Stanford Univ, Dept Neurol & Neurol Sci, Stanford Stroke Ctr, Sch Med, Stanford, CA USA

[3] Kansas Univ, Dept Neurol, Med Ctr, Kansas City, KS USA

[4] Ohio State Wexner Med Ctr, Dept Neurol, Columbus, OH USA

[5] New York Univ, Dept Radiol & Neurol, Langone Med Ctr, New York, NY USA

[6] Emory Univ Hosp, Atlanta, GA USA

[7] Taipei Med Univ Hosp, Dept Med Imaging, Taipei, Taiwan

[8] Augusta Univ, Intervent & Vasc Neurol, Augusta, GA USA

[9] Ascens Columbia St Marys Hosp, Dept Neurointervent Surg, Milwaukee, WI USA

[10] Univ Hosp Geneva, Dept Clin Neurosci, Geneva, Switzerland

[11] Univ Melbourne, Royal Melbourne Hosp, Melbourne Brain Ctr, Dept Med & Neurol, Parkville, Vic, Australia

[12] Univ Med Ctr Hamburg Eppendorf, Dept Neuroradiol, Hamburg, Germany

[13] Cantonal Hosp Corp, Neurocenter Southern Switzerland, Dept Neuroradiol, Lugano, Switzerland

[14] Stanford Univ, Dept Radiol, Sch Med, Stanford, CA USA

来源：

ANNALS OF NEUROLOGY | 2022年 / 91卷 / 01期

关键词：

INTRAVENOUS T-PA; ENDOVASCULAR TREATMENT; ISCHEMIC-STROKE; OCCLUSION; THERAPY; RECANALIZATION; CIRCULATION; SELECTION; CT;

D O I：

10.1002/ana.26272

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

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 2021

引用

页码：23 / 32

页数：10

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