. 2021 Mar;52(3):811-820.

doi: 10.1161/STROKEAHA.120.031371. Epub 2021 Feb 11.

Values of Baseline Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score for Treatment Decision of Acute Basilar Artery Occlusion

Hongfei Sang^#^{1

2}, Fengli Li^#¹, Junjie Yuan¹, Shuai Liu¹, Weidong Luo¹, Changming Wen³, Qiyi Zhu⁴, Wenhuo Chen⁵, Min Lin⁶, Li Qi⁷, Yaoyi Zhong⁸, Zhen Wang⁹, Wentong Ling¹⁰, Zhonghua Shi¹¹, Huisheng Chen¹², Wenhua Liu¹³, Zhensheng Liu¹⁴, Xiaoxi Yao¹⁵, Feng Xiong¹⁶, Guoyong Zeng¹⁷, Xiaogang Hu¹⁸, Hui Dong¹⁹, An Mao²⁰, Guoqiang Yang¹, Jiacheng Huang¹, Luming Chen¹, Zili Gong¹, Jian Tao¹, Hansheng Liu¹, Deping Wu¹, Zhongming Qiu^{1

20}, Qingwu Yang¹, Wenjie Zi¹, Fangfei Li¹

Affiliations

¹ Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
² Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, China (H.S.).
³ Department of Neurology, Nanyang Central Hospital, China (C.W.).
⁴ Department of Neurology, Linyi People's Hospital, China (Q.Z.).
⁵ Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, China (W.C.).
⁶ Department of Neurology, The 900th Hospital of The People's Liberation Army, China (M.L.).
⁷ Department of Neurology, The 924th Hospital of The People's Liberation Army, China (L.Q.).
⁸ Department of Neurology, The 909th Hospital of The People's Liberation Army, China (Y.Z.).
⁹ Department of Neurology, Changsha Central Hospital, China (Z.W.).
¹⁰ Department of Neurology, Zhongshan People's Hospital, China (W. Ling).
¹¹ Department of Neurosurgery (Z.S.), The 904th Hospital of The People's Liberation Army, China.
¹² Department of Neurology, Northern Theater General Hospital of The People's Liberation Army, China (H.C.).
¹³ Department of Neurology, Wuhan No. 1 Hospital, China (W. Liu).
¹⁴ Department of Neurology, The First People's Hospital of Yangzhou, Yangzhou University, China (Z.L.).
¹⁵ Department of Neurology, The First People's Hospital of Chenzhou, China (X.Y.).
¹⁶ Department of Neurology, Zhuzhou Central Hospital, China (F.X.).
¹⁷ Department of Neurology, Ganzhou People's Hospital, China (G.Z.).
¹⁸ Department of Military Patient Management (X.H.), The 904th Hospital of The People's Liberation Army, China.
¹⁹ Department of Cadre Health Care (H.D.), The 903th Hospital of The People's Liberation Army, China.
²⁰ Department of Neurology (A.M., Z.Q.), The 903th Hospital of The People's Liberation Army, China.

^# Contributed equally.

PMID: 33567874
DOI: 10.1161/STROKEAHA.120.031371

Values of Baseline Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score for Treatment Decision of Acute Basilar Artery Occlusion

Hongfei Sang et al. Stroke. 2021 Mar.

. 2021 Mar;52(3):811-820.

doi: 10.1161/STROKEAHA.120.031371. Epub 2021 Feb 11.

Authors

Affiliations

¹ Department of Neurology, Xinqiao Hospital and The Second Affiliated Hospital, Army Medical University (Third Military Medical University), China (H.S., F. Li, J.Y., S.L., W. Luo, G.Y., J.H., L.C., Z.G., J.T., H.L., D.W., Z.Q., Q.Y., W.Z., F. Li).
² Department of Neurology, Affiliated Hangzhou First People's Hospital, Zhejiang University School of Medicine, China (H.S.).
³ Department of Neurology, Nanyang Central Hospital, China (C.W.).
⁴ Department of Neurology, Linyi People's Hospital, China (Q.Z.).
⁵ Department of Neurology, Zhangzhou Affiliated Hospital of Fujian Medical University, China (W.C.).
⁶ Department of Neurology, The 900th Hospital of The People's Liberation Army, China (M.L.).
⁷ Department of Neurology, The 924th Hospital of The People's Liberation Army, China (L.Q.).
⁸ Department of Neurology, The 909th Hospital of The People's Liberation Army, China (Y.Z.).
⁹ Department of Neurology, Changsha Central Hospital, China (Z.W.).
¹⁰ Department of Neurology, Zhongshan People's Hospital, China (W. Ling).
¹¹ Department of Neurosurgery (Z.S.), The 904th Hospital of The People's Liberation Army, China.
¹² Department of Neurology, Northern Theater General Hospital of The People's Liberation Army, China (H.C.).
¹³ Department of Neurology, Wuhan No. 1 Hospital, China (W. Liu).
¹⁴ Department of Neurology, The First People's Hospital of Yangzhou, Yangzhou University, China (Z.L.).
¹⁵ Department of Neurology, The First People's Hospital of Chenzhou, China (X.Y.).
¹⁶ Department of Neurology, Zhuzhou Central Hospital, China (F.X.).
¹⁷ Department of Neurology, Ganzhou People's Hospital, China (G.Z.).
¹⁸ Department of Military Patient Management (X.H.), The 904th Hospital of The People's Liberation Army, China.
¹⁹ Department of Cadre Health Care (H.D.), The 903th Hospital of The People's Liberation Army, China.
²⁰ Department of Neurology (A.M., Z.Q.), The 903th Hospital of The People's Liberation Army, China.

^# Contributed equally.

PMID: 33567874
DOI: 10.1161/STROKEAHA.120.031371

Abstract

Background and purpose: This study aimed to analyze the impact of baseline posterior circulation Acute Stroke Prognosis Early Computed Tomography Score (pc-ASPECTS) on the efficacy and safety of endovascular therapy (EVT) for patients with acute basilar artery occlusion.

Methods: The BASILAR was a nationwide prospective registry of consecutive patients with a symptomatic and radiologically confirmed acute basilar artery occlusion within 24 hours of symptom onset. We estimated the effect of standard medical therapy alone (SMT group) versus SMT plus EVT (EVT group) for patients with documented pc-ASPECTS on noncontrast CT, both as a categorical (0-4 versus 5-7 versus 8-10) and as a continuous variable. The primary outcomes included favorable functional outcomes (modified Rankin Scale ≤3) at 90 days and mortality within 90 days.

Results: In total, 823 cases were included: 468 with pc-ASPECTS 8 to 10 (SMT: 71; EVT: 397), 317 with pc-ASPECTS 5 to 7 (SMT: 85; EVT: 232), and 38 with pc-ASPECTS 0 to 4 (SMT: 13; EVT: 25). EVT was associated with higher rate of favorable outcomes (adjusted relative risk with 95% CI, 4.35 [1.30-14.48] and 3.20 [1.68-6.09]; respectively) and lower mortality (60.8% versus 77.6%, P=0.005 and 35.0% versus 66.2%, P<0.001; respectively) than SMT in the pc-ASPECTS 5 to 7 and 8 to 10 subgroups. Continuous benefit curves also showed the superior efficacy and safety of EVT over SMT in patients with pc-ASPECTS ≥5. Furthermore, the prognostic effect of onset to puncture time on favorable outcome with EVT was not significant after adjustment for pc-ASPECTS (adjusted odds ratio, 0.98 [95% CI, 0.94-1.02]).

Conclusions: Patients of basilar artery occlusion with pc-ASPECTS ≥5 could benefit from EVT. The baseline pc-ASPECTS appears more important for decision making and predicting prognosis than time to EVT. Registration: URL: http://www.chictr.org.cn. Unique identifier: ChiCTR1800014759.

Keywords: basilar artery; decision making; noncontrast computed tomography; prognosis; thrombectomy.

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Values of Baseline Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score for Treatment Decision of Acute Basilar Artery Occlusion

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Values of Baseline Posterior Circulation Acute Stroke Prognosis Early Computed Tomography Score for Treatment Decision of Acute Basilar Artery Occlusion

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