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Pallesen LP, Gerber J, Dzialowski I, van der Hoeven EJRJ, Michel P, Pfefferkorn T, Ozdoba C, Kappelle LJ, Wiedemann B, Khomenko A, Algra A, Hill MD, von Kummer R, Demchuk AM, Schonewille WJ, Puetz V. Diagnostic and Prognostic Impact of pc-ASPECTS Applied to Perfusion CT in the Basilar Artery International Cooperation Study. J Neuroimaging 2014; 25:384-9. [PMID: 24942473 DOI: 10.1111/jon.12130] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 02/20/2014] [Accepted: 03/31/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND AND PURPOSE The posterior circulation Acute Stroke Prognosis Early CT Score (pc-APECTS) applied to CT angiography source images (CTA-SI) predicts the functional outcome of patients in the Basilar Artery International Cooperation Study (BASICS). We assessed the diagnostic and prognostic impact of pc-ASPECTS applied to perfusion CT (CTP) in the BASICS registry population. METHODS We applied pc-ASPECTS to CTA-SI and cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT) parameter maps of BASICS patients with CTA and CTP studies performed. Hypoattenuation on CTA-SI, relative reduction in CBV or CBF, or relative increase in MTT were rated as abnormal. RESULTS CTA and CTP were available in 27/592 BASICS patients (4.6%). The proportion of patients with any perfusion abnormality was highest for MTT (93%; 95% confidence interval [CI], 76%-99%), compared with 78% (58%-91%) for CTA-SI and CBF, and 46% (27%-67%) for CBV (P < .001). All 3 patients with a CBV pc-ASPECTS < 8 compared to 6/23 patients with a CBV pc-ASPECTS ≥ 8 had died at 1 month (RR 3.8; 95% CI, 1.9-7.6). CONCLUSION CTP was performed in a minority of the BASICS registry population. Perfusion disturbances in the posterior circulation were most pronounced on MTT parameter maps. CBV pc-ASPECTS < 8 may indicate patients with high case fatality.
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Affiliation(s)
- Lars-Peder Pallesen
- Dresden University Stroke Center, University of Technology Dresden, Dresden, Germany
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Nagel S, Schellinger PD, Hartmann M, Juettler E, Huttner HB, Ringleb P, Schwab S, Köhrmann M. Therapy of Acute Basilar Artery Occlusion. Stroke 2009; 40:140-6. [PMID: 18927446 DOI: 10.1161/strokeaha.108.526566] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
While intravenous recombinant tissue plasminogen activator (rt-PA) has been approved for acute stroke therapy within 3 hours, the optimum management of basilar artery occlusion (BAO) is still a matter of debate. We compared intraarterial thrombolysis with the combined bridging approach of intravenous abciximab and intraarterial thrombolysis with rt-PA (bridging therapy) in an observational, longitudinal, monocenter study.
Methods—
Between 1998 and 2006, information for 106 patients with acute BAO were prospectively entered into a local database. Patients eligible for treatment received either intraarterial thrombolysis with rt-PA alone (intraarterial thrombolysis) or were treated with intravenous abciximab and intraarterial rt-PA (bridging therapy). Outcome parameters were recanalization of the basilar artery according to Trial in Myocardial Infarction criteria, survival, and reduction of severe disability and death at 3 months. Logistic regression was used to identify independent predictors for recanalization, survival, and clinical outcome.
Results—
Of a total of 106 patients with confirmed BAO, 87 patients underwent subsequent angiography. Among those, 75 patients were identified who received the full treatment protocol. Patients in the bridging group had a better recanalization rate (83.7% vs 62.5%;
P
=0.03), a higher survival rate (58.1% vs 25%;
P
=0.01), and a better chance for an outcome with no or only mild to moderate disability (modified Rankin Scale score, 0–3; 34.9% vs 12.5%;
P
=0.02). Symptomatic intracerebral hemorrhage rates were comparable in both groups (14% in the bridging group vs 18.8%;
P
=0.41). Independent predictors for recanalization were age (OR, 0.95; 95% CI, 0.91–0.99), atrial fibrillation (OR, 6.53; 95% CI, 1.14–37.49), and bridging therapy (OR, 3.37; 95% CI, 1.02 to 11.18). Independent prognostic factors for outcome were Glasgow coma scale score at presentation (OR, 1.24; 95% CI, 1.03–1.45) and the combination of bridging therapy with successful recanalization (OR, 3.744; 95% CI, 1.04–13.43).
Conclusion—
Bridging therapy for acute BAO with intravenous abciximab and intraarterial rt-PA appears to be safe and yields higher recanalization and improved survival rates, as well as an overall improved chance for a better outcome.
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Affiliation(s)
- Simon Nagel
- From Department of Neurology (S.N., E.J., P.R.), University of Heidelberg, Medical School, Germany; Department of Neurology (P.D.S., H.B.H., S.S., M.K.), University of Erlangen, Medical School, Germany; Department of Neuroradiology (M.H., E.J.), University of Heidelberg, Medical School, Germany; Acute Stroke Programme (S.N.), Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Peter D. Schellinger
- From Department of Neurology (S.N., E.J., P.R.), University of Heidelberg, Medical School, Germany; Department of Neurology (P.D.S., H.B.H., S.S., M.K.), University of Erlangen, Medical School, Germany; Department of Neuroradiology (M.H., E.J.), University of Heidelberg, Medical School, Germany; Acute Stroke Programme (S.N.), Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Marius Hartmann
- From Department of Neurology (S.N., E.J., P.R.), University of Heidelberg, Medical School, Germany; Department of Neurology (P.D.S., H.B.H., S.S., M.K.), University of Erlangen, Medical School, Germany; Department of Neuroradiology (M.H., E.J.), University of Heidelberg, Medical School, Germany; Acute Stroke Programme (S.N.), Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Eric Juettler
- From Department of Neurology (S.N., E.J., P.R.), University of Heidelberg, Medical School, Germany; Department of Neurology (P.D.S., H.B.H., S.S., M.K.), University of Erlangen, Medical School, Germany; Department of Neuroradiology (M.H., E.J.), University of Heidelberg, Medical School, Germany; Acute Stroke Programme (S.N.), Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Hagen B. Huttner
- From Department of Neurology (S.N., E.J., P.R.), University of Heidelberg, Medical School, Germany; Department of Neurology (P.D.S., H.B.H., S.S., M.K.), University of Erlangen, Medical School, Germany; Department of Neuroradiology (M.H., E.J.), University of Heidelberg, Medical School, Germany; Acute Stroke Programme (S.N.), Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Peter Ringleb
- From Department of Neurology (S.N., E.J., P.R.), University of Heidelberg, Medical School, Germany; Department of Neurology (P.D.S., H.B.H., S.S., M.K.), University of Erlangen, Medical School, Germany; Department of Neuroradiology (M.H., E.J.), University of Heidelberg, Medical School, Germany; Acute Stroke Programme (S.N.), Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Stefan Schwab
- From Department of Neurology (S.N., E.J., P.R.), University of Heidelberg, Medical School, Germany; Department of Neurology (P.D.S., H.B.H., S.S., M.K.), University of Erlangen, Medical School, Germany; Department of Neuroradiology (M.H., E.J.), University of Heidelberg, Medical School, Germany; Acute Stroke Programme (S.N.), Nuffield Department of Clinical Medicine, University of Oxford, UK
| | - Martin Köhrmann
- From Department of Neurology (S.N., E.J., P.R.), University of Heidelberg, Medical School, Germany; Department of Neurology (P.D.S., H.B.H., S.S., M.K.), University of Erlangen, Medical School, Germany; Department of Neuroradiology (M.H., E.J.), University of Heidelberg, Medical School, Germany; Acute Stroke Programme (S.N.), Nuffield Department of Clinical Medicine, University of Oxford, UK
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