Computed Tomography Perfusion Parameters: A Potential Tool for Treatment Selection in Basilar Artery Occlusion

IF 7.7 1区医学 Q1 CLINICAL NEUROLOGY Annals of Neurology Pub Date : 2025-04-02 DOI:10.1002/ana.27214

Cong Luo MD, Thanh N. Nguyen MD, Rui Li MD, PhD, Chunrong Tao MD, PhD, Xiaozhong Jing MD, PhD, Li Wang MD, Anmo Wang MD, PhD, Yuyu Zhou MD, Feiyang Gao MD, Keyi Zhang MD, Raul G. Nogueira MD, Wei Hu MD, PhD, ATTENTION Investigators

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Abstract

Objective

This study aimed to evaluate the association between computed tomography perfusion (CTP) parameters and outcomes in basilar artery occlusion (BAO), and to select patients with BAO who may benefit from thrombectomy.

Methods

We performed a post-hoc analysis of patients from the ATTENTION trial with available admission CTP data. CTP parameters evaluated included time to maximum (T_max) >6 s/8 s/10 s, relative cerebral blood flow (rCBF) <20%/30%/34%/38%/50%, Critical Area Perfusion Score (CAPS), and CTP-posterior circulation acute stroke prognosis early computed tomography score (CTP-pc-ASPECTS), pons-midbrain-thalamus (PMT) hypoperfusion. Multivariable Firth logistic regression was used to analyze associations between CTP parameters and outcomes and to explore treatment interactions. The primary outcome was favorable outcome, defined as modified Rankin Scale score of 0–3, at 90 days.

Results

The study included 109 patients (70 thrombectomy, 39 control). Multivariable analysis showed that lower CAPS, smaller rCBF <34% volume, and higher CTP-pc-ASPECTS were associated with favorable outcome. Patients who underwent thrombectomy had a higher likelihood of favorable outcome with increasing CAPS (T_max > 6 s) compared to control (P_interaction = 0.048 for continuous variable). When CAPS (T_max > 6 s) was treated as a categorical variable, the interaction remained significant (P_interaction = 0.03). Similarly, the treatment effect was also modified by PMT hypoperfusion (T_max >6 s) (P_interaction = 0.03). In patients with CAPS (T_max >6 s) >3 or with PMT hypoperfusion (T_max >6 s), thrombectomy was associated with favorable outcome.

Interpretation

Higher CAPS correlated with a decrease in the rate of favorable outcomes. However, patients with higher CAPS were more likely to benefit from thrombectomy compared to medical management alone, suggesting that severe hypoperfusion should not preclude endovascular treatment. ANN NEUROL 2025;98:185–196

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计算机断层灌注参数：基底动脉闭塞治疗选择的潜在工具。

目的：本研究旨在评估基底动脉闭塞（BAO）的ct灌注（CTP）参数与预后的关系，并选择可能从血栓切除术中获益的BAO患者。方法：我们利用现有的入院CTP数据对来自ATTENTION试验的患者进行了事后分析。CTP参数评估包括到达最大时间（Tmax） bb0 6 s/8 s/10 s，相对脑血流量（rCBF）。结果：研究纳入109例患者（70例取栓，39例对照组）。多变量分析结果显示，与对照组相比，CAPS越低，rCBF max越小（连续变量p交互作用= 0.048）。当CAPS （Tmax bbb60 s）作为分类变量时，交互作用仍然显著（p交互作用= 0.03）。同样，PMT低灌注（Tmax bbb6 s）对治疗效果也有影响（p - interaction = 0.03）。在CAPS (Tmax >6 s) >3 s或PMT灌注不足（Tmax >6 s）的患者中，取栓与良好的预后相关。解释：较高的CAPS与较低的有利结果率相关。然而，与单纯药物治疗相比，CAPS较高的患者更有可能从取栓术中获益，这表明严重灌注不足不应排除血管内治疗。Ann neurol 2025。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Annals of Neurology 医学-临床神经学

CiteScore

18.00

自引率

1.80%

发文量

270

审稿时长

3-8 weeks

期刊介绍： Annals of Neurology publishes original articles with potential for high impact in understanding the pathogenesis, clinical and laboratory features, diagnosis, treatment, outcomes and science underlying diseases of the human nervous system. Articles should ideally be of broad interest to the academic neurological community rather than solely to subspecialists in a particular field. Studies involving experimental model system, including those in cell and organ cultures and animals, of direct translational relevance to the understanding of neurological disease are also encouraged.

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