CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study

Lars P Pallesen; Andrei Khomenko; Imanuel Dzialowski; Jessica Barlinn; Kristian Barlinn; Charlotte Zerna; Erik Jrj van der Hoeven; Ale Algra; L Jaap Kapelle; Patrik Michel; Ulf Bodechtel; Andrew M Demchuk; Wouter Schonewille; Volker Puetz; BASICS-Study group

doi:10.1177/1747493016669886

CT-angiography source images indicate less fatal outcome despite coma of patients in the Basilar Artery International Cooperation Study

Int J Stroke. 2017 Feb;12(2):145-151. doi: 10.1177/1747493016669886. Epub 2016 Oct 3.

Authors

Lars P Pallesen¹, Andrei Khomenko², Imanuel Dzialowski³, Jessica Barlinn¹, Kristian Barlinn¹, Charlotte Zerna^{1

4}, Erik Jrj van der Hoeven⁵, Ale Algra^{6

7}, L Jaap Kapelle⁶, Patrik Michel⁸, Ulf Bodechtel¹, Andrew M Demchuk⁴, Wouter Schonewille^{5

6}, Volker Puetz¹; BASICS-Study group

Affiliations

¹ 1 Department of Neurology, University of Technology Dresden, Dresden, Germany.
² 2 Department of Neurology, University of Regensburg, Regensburg, Germany.
³ 3 Department of Neurology, Elblandklinikum Meissen, Meissen, Germany.
⁴ 4 Calgary Stroke Program, University of Calgary, Calgary, Canada.
⁵ 5 St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands.
⁶ 6 Department of Neurology and Neurosurgery, Brain Center Rudolf Magnus, University Medical Center, Utrecht, The Netherlands.
⁷ 7 Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, The Netherlands.
⁸ 8 Centre Hospitalier Universitaire Vaudois, Centre Cérébrovasculaire, Lausanne, Switzerland.

PMID: 27698280
DOI: 10.1177/1747493016669886

Abstract

Background Coma is associated with poor outcome in patients with basilar artery occlusion. Aims We sought to assess whether the posterior circulation Acute Stroke Prognosis Early CT Score and the Pons-Midbrain Index applied to CT angiography source images predict the outcome of comatose patients in the Basilar Artery International Cooperation Study. Methods Basilar Artery International Cooperation Study was a prospective, observational registry of patients with acute basilar artery occlusion with 48 recruiting centers worldwide. We applied posterior circulation Acute Stroke Prognosis Early CT Score and Pons-Midbrain Index to CT angiography source images of Basilar Artery International Cooperation Study patients who presented with coma. We calculated adjusted risk ratios to assess the association of dichotomized posterior circulation Acute Stroke Prognosis Early CT Score (≥8 vs. <8) and Pons-Midbrain Index (<3 vs. ≥3) with mortality and favourable outcome (modified Rankin Scale score 0-3) at one month. Results Of 619 patients in the Basilar Artery International Cooperation Study registry, CT angiography source images were available for review in 158 patients. Among these, 78 patients (49%) presented with coma. Compared to non-comatose patients, comatose patients were more likely to die (risk ratios 2.34; CI 95% 1.56-3.52) and less likely to have a favourable outcome (risk ratios 0.44; CI 95% 0.24-0.80). Among comatose patients, a Pons-Midbrain Index < 3 was related to reduced mortality (adjusted RR 0.66; 95% CI 0.46-0.96), but not to favourable outcome (adjusted RR 1.19; 95% CI 0.39-3.62). Posterior circulation Acute Stroke Prognosis Early CT Score dichotomized at ≥ 8 vs. <8 was not significantly associated with death (adjusted RR 0.70; 95% CI 0.46-1.05). Conclusion In comatose patients with basilar artery occlusion, the extent of brainstem ischemia appears to be related to mortality but not to favourable outcome.

Keywords: Basilar artery occlusion; CTA source images; coma; imaging scores; ischemic stroke; thrombolysis.

Publication types

Multicenter Study
Observational Study
Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Aged, 80 and over
Basilar Artery / diagnostic imaging
Brain / diagnostic imaging*
Coma / diagnostic imaging*
Coma / etiology
Coma / mortality*
Computed Tomography Angiography*
Female
Humans
Male
Middle Aged
Prospective Studies
Registries
Severity of Illness Index
Vertebrobasilar Insufficiency / complications
Vertebrobasilar Insufficiency / diagnostic imaging*
Vertebrobasilar Insufficiency / mortality*
Young Adult