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(Stroke. 2008;39:2485.)
© 2008 American Heart Association, Inc.

Original Contributions

Extent of Hypoattenuation on CT Angiography Source Images Predicts Functional Outcome in Patients With Basilar Artery Occlusion

Volker Puetz, MD; P.N. Sylaja, MD; Shelagh B. Coutts, MD; Michael D. Hill, MD, MSc; Imanuel Dzialowski, MD; Pia Mueller, MD; Ulf Becker, MD; Gabriele Urban; Christine O'Reilly, BSc; Philip A. Barber, MD; Pranshu Sharma, MD; Mayank Goyal, MD; Georg Gahn, MD; Ruediger von Kummer, MD Andrew M. Demchuk, MD

From the Calgary Stroke Program, Department of Clinical Neurosciences (V.P., P.N.S., S.B.C., M.D.H., I.D., C.O., P.A.B., P.S., A.M.D.), University of Calgary, Canada; Dresden University Stroke Center, Department of Neurology (V.P., I.D., U.B., G.U., G.G.), University of Technology Dresden, Germany; Ananthapuri Hospitals and Research Institute (P.N.S.), Thiruvananthapuram, India; the Department of Neuroradiology (P.M., R.v.K.), University of Technology Dresden, Germany; and the Department of Neuroradiology (P.S., M.G.), University of Calgary, Canada.

Correspondence to Volker Puetz, MD, University of Technology Dresden, Department of Neurology, Dresden University Stroke Center, Fetscherstrasse 74, 01307 Dresden, Germany. E-mail volker.puetz{at}neuro.med.tu-dresden.de

Background and Purpose— Quantification of early ischemic changes (EIC) may predict functional outcome in patients with basilar artery occlusion (BAO). We tested the validity of a novel CT score, the posterior circulation Acute Stroke Prognosis Early CT score (pc-ASPECTS).

Methods— Pc-ASPECTS allots the posterior circulation 10 points. Two points each are subtracted for EIC in midbrain or pons and 1 point each for EIC in left or right thalamus, cerebellum or PCA-territory, respectively. We studied 2 different populations: (1) patients with suspected vertebrobasilar ischemia and (2) patients with BAO. We applied pc-ASPECTS to noncontrast CT (NCCT), CT angiography source images (CTASI), and follow-up image by 3-reader consensus. We calculated sensitivity for ischemic changes and analyzed the predictivity of pc-ASPECTS for independent (modified Rankin Scale [mRS] score 2) and favorable (mRS score 3) outcome.

Results— Of 130 patients with suspected vertebrobasilar ischemia, 72% (94) had posterior circulation stroke, 8% (10) transient ischemic attack, and 20% (26) nonischemic etiology. Sensitivity for ischemic changes was improved with CTASI compared to NCCT (65% [95% CI, 57% to 73%] versus 46% [95% CI, 37% to 55%], respectively). Pc-ASPECTS score on CTASI but not NCCT predicted functional independence (OR 1.58; P=0.005 versus 1.22; P=0.42, respectively). Of 46 patients with BAO, 52% (12/23) with CTASI pc-ASPECTS score 8 but only 4% (1/23) with a score <8 had favorable functional outcome (RR 12.1; 95% CI, 1.7 to 84.9). This difference was consistent in 21 patients with angiographic recanalization (RR 7.7; 95% CI, 1.1 to 52.1).

Conclusion— The CTASI pc-ASPECTS score may identify BAO patients unlikely to have a favorable outcome despite recanalization.

Key Words: stroke • acute • CT angiography • basilar artery • posterior cerebral artery stroke • stroke • ischemic

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