Deans' stroke musings: Computed tomography perfusion deficit volume predicts the functional outcome of endovascular therapy for basilar artery occlusion

Changing stroke rehab and research worldwide now.Time is Brain! trillions and trillions of neurons that DIE each day because there are NO effective hyperacute therapies besides tPA(only 12% effective). I have 523 posts on hyperacute therapy, enough for researchers to spend decades proving them out. These are my personal ideas and blog on stroke rehabilitation and stroke research. Do not attempt any of these without checking with your medical provider. Unless you join me in agitating, when you need these therapies they won't be there.

What this blog is for:

My blog is not to help survivors recover, it is to have the 10 million yearly stroke survivors light fires underneath their doctors, stroke hospitals and stroke researchers to get stroke solved. 100% recovery. The stroke medical world is completely failing at that goal, they don't even have it as a goal. Shortly after getting out of the hospital and getting NO information on the process or protocols of stroke rehabilitation and recovery I started searching on the internet and found that no other survivor received useful information. This is an attempt to cover all stroke rehabilitation information that should be readily available to survivors so they can talk with informed knowledge to their medical staff. It lays out what needs to be done to get stroke survivors closer to 100% recovery. It's quite disgusting that this information is not available from every stroke association and doctors group.

Saturday, March 9, 2024

Computed tomography perfusion deficit volume predicts the functional outcome of endovascular therapy for basilar artery occlusion

Predicting high risk is totally fucking useless without protocols to address and alleviate that risk! Does anyone in stroke actually have two functioning neurons to rub together?

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https://doi.org/10.1016/j.jstrokecerebrovasdis.2024.107677 Get rights and content

Abstract

Objectives

To investigate the relationship between baseline computed tomography perfusion deficit volumes and functional outcomes in patients with basilar artery occlusion (BAO) undergoing endovascular therapy.

Methods

This was a single-center study in which the data of 64 patients with BAO who underwent endovascular therapy were retrospectively analyzed. All the patients underwent multi-model computed tomography on admission. The posterior-circulation Acute Stroke Prognosis Early Computed Tomography Score was applied to assess the ischemic changes. Perfusion deficit volumes were obtained using Syngo.via software. The primary outcome of the analysis was a good functional outcome (90-day modified Rankin Scale score ≤ 3). Logistic regression and correlation analyses were used to explore predictors of functional outcome.

Results

A total of 64 patients (median age, 68 years; 72% male) were recruited, of whom 26 (41%) patients achieved good functional outcomes, while 38 (59%) had poor functional outcomes. Tmax > 10 seconds, Tmax > 6 seconds, and rCBF < 30% volume were independent predictors of good functional outcomes (odds ratio range, 1.0–1.2; 95% confidence interval [CI], 1.0–1.4]) and performed well in the receiver operating characteristic curve analyses, exhibiting positive prognostic value; the areas under the curve values were 0.85 (95% CI, 0.75–0.94), 0.81 (95% CI, 0.70–0.90), and 0.78 (95% CI, 0.67–0.89).

Conclusion

Computed tomography perfusion deficit volume represents a valuable tool in predicting high risk of disability and mortality in patients with BAO after basilar endovascular treatment.

Introduction

Basilar artery occlusion (BAO) is estimated to have an annual incidence of 4 cases per 100,000¹, accounting for 1% of all ischemic strokes. BAO results in death and disability in approximately 80% of affected patients who do not undergo intervention and it is currently a prominent cause of disability and death in stroke²^,³. Guidelines recommend endovascular treatment (EVT) as a treatment for anterior circulation occlusion⁴. The results of recent randomized trials, including the Basilar Artery Occlusion Chinese Endovascular trials (BAOCHE)⁵, Acute Basilar Artery Occlusion Study (BASILAR)⁶, and Trial of Endovascular Treatment of Acute Basilar-Artery Occlusion (ATTENTION) ⁷, showed that EVT led to a higher percentage of good functional status 90 days post-procedure compared with medical therapy among patients with stroke due to BAO. EVT is expected to benefit patients with BAO; however, it requires an effective patient selection strategy⁸^,⁹.

Using a correct imaging method could help predict the functional outcomes for patients with BAO10, 11, 12. The most commonly used imaging method for stroke is non-contrast computed tomography (NCCT), which can effectively exclude hemorrhagic strokes. Computed tomography angiography (CTA) is valuable for detecting vascular occlusions and is often used to select patients for EVT. The posterior-circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) ¹³ is a predictor of clinical functional outcome of posterior circulation in ischemic patients. The pc-ASPECTS score based on computed tomography perfusion (CTP) images has higher value than the pc-ASPECTS score based on conventional NCCT and CTA source images (CTA-SI) for ultra-early stroke exploration and prognosis prediction¹⁴.Notably, CTP deficit volume is closely related to the functional prognosis of patients with ischemic stroke. Patients with an ischemic core of ≥70 mL do not benefit from EVT regardless of the imaging method used¹⁵. The DAWN¹⁶ and DEFUSE 3¹⁵ studies conditionally extended the window of time for EVT of ischemic stroke in the anterior circulation through perfusion deficit volume from the original 6 hours to 24 hours. However, few studies on posterior circulation hypoperfusion volumes exist, and the criteria, such as the DAWN¹⁶ and DEFUSE 3¹⁵ studies, that can be used for selecting patients with BAO for EVT beyond this window of time are not uniform. To date, no large, randomized trials of EVT in patients with BAO has used CTP deficit volumes as an inclusion criteria for patient screening.

Our study aimed to determine CTP parameters that can support clinical decision-making, using the automated software Syngo.via (Siemens) to explore the relationship between perfusion deficit volume and functional outcomes in patients with BAO undergoing EVT.