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(Stroke. 2008;39:3107.)
© 2008 American Heart Association, Inc.

Research Letters

CT Angiography-Source Image Hypoattenuation Predicts Clinical Outcome in Posterior Circulation Strokes Treated With Intra-Arterial Therapy

Pamela W. Schaefer, MD; Albert J. Yoo, MD; Donnie Bell, MD; Elizabeth R. Barak, MD; Javier M. Romero, MD; Raul G. Nogueira, MD; Michael H. Lev, MD; Lee H. Schwamm, MD; Ramon G. Gonzalez, MD, PhD Joshua A. Hirsch, MD

From the Departments of Radiology (P.W.S., A.J.Y., D.B., E.R.B., J.M.R., R.G.N., M.H.L., R.G.G., J.A.H.) and Neurology (L.H.S.), Massachusetts General Hospital, Harvard Medical School, Boston, Mass.

Correspondence to Pamela W. Schaefer, MD, Department of Radiology, Division of Neuroradiology, Gray 375, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114. E-mail pschaefer{at}partners.org

Background and Purpose— The aim of this study was to correlate CT angiography-source image (CTA-SI) parenchymal hypoattenuation with clinical outcome in patients with vertebrobasilar occlusion treated with intra-arterial thrombolysis.

Methods— In 16 patients with vertebrobasilar occlusion treated with intra-arterial thrombolysis, we graded CTA-SI parenchymal hypoattenuation in the medulla, pons, midbrain, thalamus, cerebellum, occipital lobe, inferior parietal lobe, and medial temporal lobe. The grading scale was: 0, no hypoattenuation; 1, <50% hypoattenuation; and 2, >50% hypoattenuation. On CTA, we assessed clot location and length and collaterals. Outcome was measured with modified Rankin score.

Results— Mean patient age was 68.3 years (range, 47 to 86 years), National Institutes of Health Stroke Scale was 28 (range, 11 to 40), time to CTA was 5.2 hours (range, 0.69 to 15.32), and time from CTA to intra-arterial thrombolysis was 5 hours (range, 2.25 to 10.38 hours). There were 4 basilar, 2 vertebral, and 10 combined occlusions. Eleven patients had near complete, 4 had partial, and one had no recanalization. Independent outcome predictors measured as modified Rankin score at 3 months were CTA-SI pons and midbrain scores(cumulative r=0.81, P<0.001). For outcome dichotomized into death versus survival, the CTA-SI pons score (P=0.0037) was the only independent predictor.

Conclusion— Hypoattenuation in the pons and midbrain on pretreatment CTA-SI correlates highly with clinical outcome in patients with vertebrobasilar occlusion treated with intra-arterial thrombolysis.

Key Words: acute stroke • CT • ischemia • neuroradiology • perfusion • stroke • therapy

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