Proposal for a Vascular Computed Tomography-Based Grading System in Posterior Circulation Stroke: A Single-Center Experience

Valerio Da Ros, Alessandro Meschini, Roberto Gandini, Costantino Del Giudice, Francesco Garaci, Paolo Stanzione, Barbara Rizzato, Marina Diomedi, Giovanni Simonetti, Roberto Floris, Fabrizio Sallustio

Research output: Contribution to journalArticlepeer-review

Abstract

Objective The aim of this study is to investigate the role of a computed tomography angiography (CTA)-based approach in patients undergoing mechanical thrombectomy for vertebrobasilar stroke treatment. Methods A CTA and digital subtraction angiography (DSA) retrospective analysis of patients with acute vertebrobasilar stroke treated with thrombectomy was performed. A modified Rankin Scale score of 3 or lower at 3 months was considered as favorable outcome. The posterior circulation ASPECTS (pc-ASPECTS) was evaluated on CTA and vertebrobasilar segments involved in the occlusion were assessed using a 6-point posterior circulation computed tomography angiography (pc-CTA) vascular score aimed at evaluating the posterior circulation vascular pattern including collaterals. The primary end point was the correlation between pc-CTA and outcome; secondary end points included the concordance between CTA-DSA images and the correlation between pc-ASPECTS and outcome. Results Fifteen patients with vertebrobasilar stroke were retrospectively analyzed. All patients in coma showed a bad outcome (P =.01) and all patients with an alert state showed a good outcome (P =.004). An excellent interobserver agreement for pc-CTA (P =.001) was observed with poor interobserver agreement for pc-ASPECTS (P =.21). No significant correlations between pc-ASPECTS and clinical outcome were observed. Patients with good outcome had a lower pc-CTA (P =.02). The patency of the distal third of the basilar artery and both posterior cerebral arteries was related with good outcome. Conclusion The pc-CTA seems to have prognostic value in patients with vertebrobasilar stroke undergoing mechanical thrombectomy. It may be used as an additional prognostic triage technique in this subgroup of stroke patients.

Original languageEnglish
Pages (from-to)368-377
Number of pages10
JournalJournal of Stroke and Cerebrovascular Diseases
Volume25
Issue number2
DOIs
Publication statusPublished - Feb 1 2016
Externally publishedYes

Keywords

  • ASPECTS
  • basilar artery
  • computed tomography angiography
  • neurothrombectomy
  • Stroke

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Rehabilitation
  • Cardiology and Cardiovascular Medicine

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