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Original research
Posterior circulation CT angiography collaterals predict outcome of endovascular acute ischemic stroke therapy for basilar artery occlusion
  1. Nitin Goyal1,
  2. Georgios Tsivgoulis1,2,
  3. Chris Nickele3,
  4. Vinodh T Doss1,3,
  5. Dan Hoit3,
  6. Andrei V Alexandrov1,
  7. Adam Arthur3,
  8. Lucas Elijovich1,3
  1. 1Department of Neurology, University of Tennessee Health Science Center, Memphis, Tennessee, USA
  2. 2Second Department of Neurology, “Attikon” Hospital, School of Medicine, University of Athens, Athens, Greece
  3. 3Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, University of Tennessee Health Sciences Center, Memphis, Tennessee, USA
  1. Correspondence to Dr Lucas Elijovich, Department of Neurology, University of Tennessee Health Sciences Center, Semmes-Murphey Neurologic and Spine Institute, 6325 Humphreys Blvd, Memphis, TN 38120,USA; lelijovich{at}semmes-murphey.com

Abstract

Introduction The natural history of acute ischemic stroke (AIS) due to basilar artery occlusion (BAO) is poor. Endovascular reperfusion therapy (EVT) improves recanalization rates in patients with emergent large vessel intracranial occlusion.

Objective To examine the hypothesis that good collateral patterns identified by pretreatment CT angiography (CTA) might be associated with favorable outcomes after EVT.

Methods We conducted a retrospective chart review of patients presenting with AIS due to BAO in a tertiary care stroke center during a 4-year period. BAO was diagnosed by CTA in all cases. Admission stroke severity was documented using the National Institute of Health Stroke Scale (NIHSS) score. Pretreatment collateral score for posterior circulation was defined as follows: 0, no posterior communicating artery (PCOM); 1, unilateral PCOM; 2, bilateral PCOM. Favorable outcome was defined as modified Rankin Scale score of 0–2 at 3 months.

Results A total of 21 patients with AIS due to BAO (age range 31–84 years, median admission NIHSS score: 18 points, range 2–38) underwent EVT. Eleven of 21 patients (52.4%) had bilateral PCOMs, while unilateral PCOM was seen in 3 patients (14.3%). Patients with bilateral PCOMs tended (p=0.261) to have less severe stroke at admission than those with absent/unilateral PCOM (median NIHSS score 18 vs 27 points). Neurological improvement during hospitalization (quantified by the median decrease in NIHSS score) and the rate of 3-month functional independence were greater in patients with good collaterals (16 vs 0 points (p=0.016) and 72.7% vs 0% (p=0.001)).

Conclusions The presence of bilateral PCOMs on pretreatment CTA appears to be associated with more favorable outcomes in BAO treated with EVT.

  • CT Angiography
  • Stroke
  • Thrombectomy
  • Thrombolysis

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